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NPI Code Detail

MEDICARE: COUNTRYSIDE NURSING AND REHABILITATION LP

MEDICARE: COUNTRYSIDE NURSING AND REHABILITATION LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1155686201OTHERTXTMHP CROSS OVER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407843998
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTRYSIDE NURSING AND REHABILITATION LP
Provider Business Mailing Address
First Line : 419 S ELM ST
Second Line :
City : DENTON
State : TX
Zip : 76201-6085
Country : US
Telephone Number : 940-387-4388
Fax Number : 940-380-2410
Provider Business Practice Location Address
First Line : 1700 N WASHINGTON ST
Second Line :
City : PILOT POINT
State : TX
Zip : 76258-3716
Country : US
Telephone Number : 940-686-5556
Fax Number : 940-686-2092
Authorized Official
Title or Position : CEO
Name : MR. DAN D. FLAGG
Credential :
Telephone Number : 940-387-4388
Provider Enumeration Date : 09/30/2005
Last Update Date : 01/30/2019

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Directions to “COUNTRYSIDE NURSING AND REHABILITATION LP ” Practice Location

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