Healthcare Provider Details

I. General information

NPI: 1225040751
Provider Name (Legal Business Name): COUNTRYSIDE CHRISTIAN COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BELLANN CT
ANNVILLE PA
17003-9012
US

IV. Provider business mailing address

200 BELLANN CT
ANNVILLE PA
17003-9012
US

V. Phone/Fax

Practice location:
  • Phone: 717-867-4636
  • Fax: 717-867-1332
Mailing address:
  • Phone: 717-867-4636
  • Fax: 717-867-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number470802
License Number StatePA

VIII. Authorized Official

Name: MISS MARY ELLEN ROHRER
Title or Position: ADMINISTRATOR
Credential:
Phone: 717-867-4636