Countryside Retirement Home of Sioux City, Iowa

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

N-0370 Issued in IA

Legal business name

COUNTRYSIDE RETIREMENT HOME OF SIOUX CITY, IOWA

Practice address

6120 Morningside Ave
Sioux City, IA 51106-3943

Phone

(712) 276-3000

Fax

(712) 266-2167

NPI assigned

Jul 15, 2005

Organization subpart

No

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

Authorized official

Name

Debbie Menzenberg

Title

Executive Director

Phone

(712) 276-3000

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Countryside Retirement Home, Inc. Doing business as

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252627200000",
    "number": "1104825876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6120 MORNINGSIDE AVE",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511063943",
            "telephone_number": "712-276-3000",
            "fax_number": "712-266-2167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6120 MORNINGSIDE AVE",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511063943",
            "telephone_number": "712-276-3000",
            "fax_number": "712-266-2167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE RETIREMENT HOME OF SIOUX CITY, IOWA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-15",
        "last_updated": "2009-09-11",
        "status": "A",
        "authorized_official_last_name": "MENZENBERG",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "712-276-3000"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "IA",
            "license": "R-0370",
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IA",
            "license": "N-0370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0800300",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Countryside Retirement Home, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Teri Marie Copple, LMHC
• Counseling and Support Services 1 Inc
• Counseling and Support Services Inc
• Countryside Health Investors LLC
• Countryside Nursing and Rehabilitation Center, LLC
• Kali Renae Covey
• Kylie J Cowdin, M.D.
• Jody Cox, CADC
• Scott David Cox, LISW
• Craig N Burhoop DDS PC

• Nursing Facility/Intermediate Care Facility in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Nursing Facility/Intermediate Care Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2009; 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.