Countryside Village Assisted Living Facility, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

COUNTRYSIDE VILLAGE ASSISTED LIVING FACILITY, LLC

Doing business as

Countryside Village Assisted Living Facility, LLC

Practice address

300 W Fairview St
King City, MO 64463-9606

Phone

(660) 535-2011

NPI assigned

Dec 27, 2024

Last updated

Dec 27, 2024By 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

Michelle L Hensley

Title

Owner

Phone

(660) 535-2011

Specialties & licenses 1

Addresses

Other names 1

• Countryside Village Assisted Living Facility, LLC Doing business as

Locations

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

{
    "created_epoch": "1735257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735257600000",
    "number": "1083422729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W FAIRVIEW ST",
            "city": "KING CITY",
            "state": "MO",
            "postal_code": "644639606",
            "telephone_number": "660-535-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W FAIRVIEW ST",
            "city": "KING CITY",
            "state": "MO",
            "postal_code": "644639606",
            "telephone_number": "660-535-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE VILLAGE ASSISTED LIVING FACILITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-27",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A",
        "authorized_official_last_name": "HENSLEY",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "660-535-2011"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Countryside Village Assisted Living Facility, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emma Bucher, DPT
• Cameron Regional Medical Center, Inc. (King City Family Health)
• Davis Management Services, Inc. (King City Manor)
• Whitney Freeman, D.O.
• Fuemmeler Holdings, LLC (Wild-Kat Estates, LLC , a series of Fuemmeler Holdings, LLC)
• Jessica Fultz, FNP-C
• Harborview King City LLC

• Assisted Living Facility in King City, MO
• Providers in King City, 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 Dec 27, 2024; 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.