Countryside Christian Community

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

470802 Issued in PA

Legal business name

COUNTRYSIDE CHRISTIAN COMMUNITY

Practice address

200 Bellann CT
Annville, PA 17003-9012

Phone

(717) 867-4636

Fax

(717) 867-1332

NPI assigned

Aug 13, 2006

Organization subpart

No

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

Authorized official

Name

Miss Mary Ellen Rohrer

Title

Administrator

Phone

(717) 867-4636

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225040751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BELLANN CT",
            "city": "ANNVILLE",
            "state": "PA",
            "postal_code": "170039012",
            "telephone_number": "717-867-4636",
            "fax_number": "717-867-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BELLANN CT",
            "city": "ANNVILLE",
            "state": "PA",
            "postal_code": "170039012",
            "telephone_number": "717-867-4636",
            "fax_number": "717-867-1332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE CHRISTIAN COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROHRER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "717-867-4636",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "470802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1014899550001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Antoinette Cantarella
• E Jessica Lynn Carroll, LPN
• Glandnair Catherine Carter, NP
• Chungyu Chang, DMD
• Cassandra Rose Clemson
• Joyce Cullen
• Brian Scott Delong, M.D.
• Tasia Dennis
• Christina Monique Desanto, PA-C
• Nicole Diamico

• Skilled Nursing Facility in Annville, PA
• Providers in Annville, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.