Countryside Care Centre LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

40931 Issued in IL

Legal business name

COUNTRYSIDE CARE CENTRE LP

Practice address

2330 W Galena Blvd
Aurora, IL 60506-4246

Phone

(630) 896-4686

Fax

(630) 896-7868

NPI assigned

Dec 20, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Michael Charles Braun

Title

Controller

Phone

(847) 583-0100

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329696000000",
    "number": "1063498285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 W GALENA BLVD",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605064246",
            "telephone_number": "630-896-4686",
            "fax_number": "630-896-7868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 W GALENA BLVD",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605064246",
            "telephone_number": "630-896-4686",
            "fax_number": "630-896-7868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE CARE CENTRE LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-20",
        "last_updated": "2012-02-20",
        "status": "A",
        "authorized_official_last_name": "BRAUN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "847-583-0100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "40931",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDPH LICENSE NUMBER",
            "identifier": "40931",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDPH FACILITY NUMBER",
            "identifier": "6002174",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Aurora, IL
• Providers in Aurora, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.