Healthcare Provider Details

I. General information

NPI: 1356092555
Provider Name (Legal Business Name): COUNTRY HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 BLACKLICK EASTERN RD STE 110
PICKERINGTON OH
43147-7702
US

IV. Provider business mailing address

8111 MANDALAY RD
BLACKLICK OH
43004-9219
US

V. Phone/Fax

Practice location:
  • Phone: 614-568-1414
  • Fax: 614-701-9934
Mailing address:
  • Phone: 614-973-3270
  • Fax: 614-701-9934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. BHIM M SUBEDI
Title or Position: OWNER/OFFICE MANAGER
Credential:
Phone: 614-568-1414