Countryside Home, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

COUNTRYSIDE HOME, LLC

Practice address

24499 Park Dr
Lebanon, MO 65536-5843

Phone

(417) 532-7418

Fax

(417) 532-9359

NPI assigned

Oct 7, 2010

Last updated

Oct 7, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mary Kay Howlett

Title

Owner/Administrator

Phone

(417) 532-7418

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286409600000",
    "number": "1043520133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24499 PARK DR",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655365843",
            "telephone_number": "417-532-7418",
            "fax_number": "417-532-9359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24499 PARK DR",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655365843",
            "telephone_number": "417-532-7418",
            "fax_number": "417-532-9359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-07",
        "last_updated": "2010-10-07",
        "status": "A",
        "authorized_official_last_name": "HOWLETT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "417-532-7418",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaelin Collison, OTR/L
• Heidi Ann Conti
• Chad Garnett Cook
• Kara Lynn Copling, CCC-SLP
• Counseling Services of Starla Walton
• Gary M. Courter, DO
• Jerry F Cox, D.D.S
• Katheryn Mae Cox, CCC-SLP
• Danielle Craig, CCC-SLP
• Crescent Center Counseling

• Assisted Living Facility in Lebanon, MO
• Providers in Lebanon, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.