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NPI Code Detail

MEDICARE: COUNTRYSIDE HEALTH INVESTORS LLC

MEDICARE: COUNTRYSIDE HEALTH INVESTORS LLC
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 FacilityIA

General Provider Information

NPI Number : 1649642976
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTRYSIDE HEALTH INVESTORS LLC
Provider Business Mailing Address
First Line : 6120 MORNINGSIDE AVE
Second Line :
City : SIOUX CITY
State : IA
Zip : 51106-3943
Country : US
Telephone Number : 712-276-3000
Fax Number : 712-266-2167
Provider Business Practice Location Address
First Line : 6120 MORNINGSIDE AVE
Second Line :
City : SIOUX CITY
State : IA
Zip : 51106-3943
Country : US
Telephone Number : 712-276-3000
Fax Number : 712-266-2167
Authorized Official
Title or Position : MEMBER
Name : MICHAEL SORRELLS
Credential :
Telephone Number : 812-525-1114
Provider Enumeration Date : 10/26/2015
Last Update Date : 10/26/2015

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Directions to “COUNTRYSIDE HEALTH INVESTORS LLC ” Practice Location

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