Provider Demographics
NPI:1063223683
Name:COUNTRYSIDE HOME INC.
Entity type:Organization
Organization Name:COUNTRYSIDE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:STILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:719-232-3208
Mailing Address - Street 1:2454 HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-6084
Mailing Address - Country:US
Mailing Address - Phone:785-576-1607
Mailing Address - Fax:
Practice Address - Street 1:2454 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-6084
Practice Address - Country:US
Practice Address - Phone:785-576-1607
Practice Address - Fax:785-263-9885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility