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NPI Code Detail

MEDICARE: COUNTRYSIDE NURSING AND REHABILITATION CENTER, LLC

MEDICARE: COUNTRYSIDE NURSING AND REHABILITATION CENTER, 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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730319674
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTRYSIDE NURSING AND REHABILITATION CENTER, LLC
Provider Business Mailing Address
First Line : 211 N BROADWAY
Second Line : SUITE 2035
City : SAINT LOUIS
State : MO
Zip : 63102-2711
Country : US
Telephone Number : 314-588-7518
Fax Number :
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 :
Authorized Official
Title or Position : MANAGER
Name : MR. MOSHE ORLINSKY
Credential :
Telephone Number : 314-588-7518
Provider Enumeration Date : 07/24/2009
Last Update Date : 09/30/2009

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