CLASSIC COUNTRY LIVING INCORPORATED (NPI# 1255408423) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255408423 |
| Entity Type | Organization |
| Organization Name | CLASSIC COUNTRY LIVING INCORPORATED |
| Practice Address |
109 Savanah Jon Blvd Boerne TX 78015-8399 |
| Practice Telephone | 8303364040 |
| Practice Fax Number | 8303364054 |
| Mailing Telephone | 8303364040 |
| Mailing Fax Number | 8303364054 |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. STARLETTE ROSE ROGGE (ADMINISTRATOR AND MANAGER) |
| Authorized Official Telephone | 8303364040 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 117205 | TX | Nursing & Custodial Care Facilities |
| Street Address |
109 SAVANAH JON BLVD |
| City | BOERNE |
| State | TX |
| Zip Code | 78015-8399 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356845242 | Samantha Royalty | Student in an Organized Health Care Education/Training Program | 31925 Deer Smt, Fair Oaks Ranch, TX 78015 | 2018-03-23 |
| 1124455985 | Charles Kennedy Jr. | Specialist | 8454 Northview Pass, Fair Oak Ranch, TX 78015 | 2013-10-10 |
| 1831448448 | Pamela Kelly Brennan | Registered Nurse | 208 Cibolo Ridge Trail, Boerne, TX 78015 | 2012-08-29 |
| 1508112558 | Tammy Marek Pllc | Counselor | 31525 Post Oak Trl, Fair Oaks Ranch, TX 78015 | 2012-07-27 |
| 1295001360 | Shanna Marie Miller | Speech-Language Pathologist | 8614 Carmel Rose, Boerne, TX 78015 | 2012-03-22 |
| 1184991184 | San Antonio Dental Center | Dentist | 8610 Napa Lndg, Boerne, TX 78015 | 2011-11-19 |
| 1386941227 | Priscilla Diane Diazdeleon | Speech-Language Pathologist | 8701 Cavalry, Fair Oaks Ranch, TX 78015 | 2011-02-11 |
| 1649586678 | Erica Janae Lunsford | Physician Assistant | 29602 Midnight Sun, Fair Oaks Ranch, TX 78015 | 2010-08-27 |
| 1053555953 | Ramon Cancino | Family Medicine | 25723 Old Fredericksburg, Boerne, TX 78015 | 2009-04-23 |
| 1194901744 | Fair Oaks Dental, Pa | Dentist | 9091 Fair Oaks Pkwy, Suite 304, Fair Oaks Ranch, TX 78015 | 2008-01-14 |
| Find all providers in zip 78015 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639727357 | Snh Longhorn Tenant LLC | Assisted Living Facility | 120 Crosspoint, Boerne, TX 78006-3102 | 2019-08-27 |
| 1770893687 | New Hope Assisted Living | Assisted Living Facility | 112 Buckskin Drive, Boerne, TX 78006 | 2010-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912507690 | Bolville LLC | Assisted Living Facility | 9898 Bissonnet St Ste 419, Houston, TX 77036-8025 | 2020-10-30 |
| 1548860067 | Zenith Care Inc | Assisted Living Facility | 1513 Baffin Bay Dr, Plano, TX 75075-2203 | 2020-10-26 |
| 1003415712 | Valarie C Williams | Assisted Living Facility | 2019 Greenwest Dr, Missouri City, TX 77489-4043 | 2020-10-23 |
| 1902404791 | Heritage Retreat Management Group, Inc. | Assisted Living Facility | 7105 Hot Creek Trce, Humble, TX 77346-3098 | 2020-10-13 |
| 1255939104 | Rance Carrington | Assisted Living Facility | 1137 W California St, Seymour, TX 76380-1552 | 2020-10-13 |
| 1083212211 | Neighbors Care, LLC | Assisted Living Facility | 3906 Everett Terrace Ln, Missouri City, TX 77459-1888 | 2020-10-10 |
| 1598362840 | Golden Age Home Care | Assisted Living Facility | 12706 Mutiny Ln, Tomball, TX 77377-8420 | 2020-10-08 |
| 1164038253 | Residential Senior Care (rsc) | Assisted Living Facility | 8040 Honeywood Trial, Port Arthur, TX 77642 | 2020-09-23 |
| 1548874670 | A Compassionate Assisted Living LLC | Assisted Living Facility | 1008 Springbrook Dr, Desoto, TX 75115-3944 | 2020-09-04 |
| 1679187975 | Arc Willowbrook, LLC | Assisted Living Facility | 7450 Willow Chase Blvd, Houston, TX 77070-5867 | 2020-09-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.