Countryside Home, LLC

NPI #1043520133 in Lebanon, Missouri

Provider Information

NPI Number: 1043520133
Entity Type: Organization
Organization Name: Countryside Home, LLC
Primary Specialty: Assisted Living Facility
Enumeration Date: Oct 7, 2010
Last Updated: Oct 7, 2010

Practice Location

Address: 24499 PARK DR
City: Lebanon
State: Missouri
ZIP Code: 65536-5843
Phone: (417) 532-7418

Authorized Official

Name: MS. MARY KAY HOWLETT
Title: OWNER/ADMINISTRATOR
Phone: (417) 532-7418

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Assisted Living Facility	310400000X	Primary

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