Countryhouse Council Bluffs LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

COUNTRYHOUSE COUNCIL BLUFFS LLC

Practice address

1831 E Kanesville Blvd
Council Bluffs, IA 51503-4767

Phone

(712) 322-4100

NPI assigned

Jun 12, 2025

Organization subpart

No

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

Authorized official

Name

Stacy Randels

Title

VP Asset Management

Phone

(531) 800-3364

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1749686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749686400000",
    "number": "1104711621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1831 E KANESVILLE BLVD",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034767",
            "telephone_number": "712-322-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1831 E KANESVILLE BLVD",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034767",
            "telephone_number": "712-322-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYHOUSE COUNCIL BLUFFS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-12",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A",
        "authorized_official_last_name": "RANDELS",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "VP ASSET MANAGEMENT",
        "authorized_official_telephone_number": "531-800-3364"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• CRC Recovery, Inc.
• Creighton University
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• Assisted Living Facility in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Assisted Living Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; 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.