Countryside Care Center, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

38-4180 Issued in MI

Legal business name

COUNTRYSIDE CARE CENTER, INC.

Practice address

2121 Robinson Rd
Jackson, MI 49203-3658

Phone

(517) 787-4150

NPI assigned

Nov 21, 2006

Organization subpart

No

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

Authorized official

Name

John Ganton

Title

Administrator

Phone

(517) 787-4150

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675296000000",
    "number": "1164597688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 ROBINSON RD",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492033658",
            "telephone_number": "517-787-4150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 ROBINSON RD",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492033658",
            "telephone_number": "517-787-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A",
        "authorized_official_last_name": "GANTON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "517-787-4150"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "38-4180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2153813",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Kathleen Cosgrove-Evens, LMSW, CAADC
• Aaron Costa
• Regina Costa, LPC LMHC CADC MCAP
• Deanna Jane Cotter, MSOT, OTRL
• Country Market Pharmacies, L.L.C.
• Amanda S Courneya, NP
• Susan Ann Cousineau
• Karen Coveart
• Adele Covington
• Amy E Cowper, LMSW

• Skilled Nursing Facility in Jackson, MI
• Providers in Jackson, MI by specialty
• Skilled Nursing Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; 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.