NPI 1316087992

Country Club II

Organisation Lodging Provider Sophia, NC

Practice location

Address: 4011 Old Courthouse Rd, Sophia, NC 27350-8866
Phone: (336) 674-6293
Mailing address: 1324 Coltrane Mill Rd, Randleman, NC 27317-8020

Authorised official

Name: Pearlie M. Bullock
Title: Administrator
Phone: (336) 674-6293

Registered specialties

Lodging Provider Primary

Other Service Providers Taxonomy 177F00000X Licence FCL076031 (NC)

Other Lodging providers in North Carolina →

Registry record

NPI: 1316087992
Entity type: Organization
NPI issued: 6 Feb 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.