NPIMap

Organization Active NPI

Countryside Hospice Care, Inc.

  • Community Based Hospice Care Agency
  • Millbrook, AL
National Provider Identifier
1295005437
Registry record updated Jan 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
01-1579PSL Issued in AL
Legal business name
COUNTRYSIDE HOSPICE CARE, INC.
Practice address
5300 Oak Tree Road
Suite B and C
Millbrook, AL 36054
Phone
(334) 285-5970
NPI assigned
Jan 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2012

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

Authorized official

Name
Michael T. Berg, J.D.
Title
Corporate Secretary
Phone
(505) 821-3355

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 01-1579PSL AL Primary

Addresses

Primary practice location

5300 Oak Tree Road
Suite B and C
Millbrook, AL 36054

Mailing address

18831 Von Karman Blvd.
Suite 400
Irvine, CA 92612-1533
Phone (949) 255-7129

Other identifiers 1

IdentifierTypeStateIssuer
PIC1579EPSLMedicaidAL

Other names 1

  • Countryside Hospice-Prattville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Countryside Hospice Care Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5300 Oaktree Rd
Ste B
Millbrook, AL 36054
Phone (334) 285-3350

18831 Von Karman Ave
Ste 400
Irvine, CA 92612
Phone (949) 255-7100

Ownership & related parties

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325721600000",
    "number": "1295005437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18831 VON KARMAN BLVD.",
            "address_2": "SUITE 400",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926121533",
            "telephone_number": "949-255-7129",
            "fax_number": "505-468-9250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 OAK TREE ROAD",
            "address_2": "SUITE B AND C",
            "city": "MILLBROOK",
            "state": "AL",
            "postal_code": "36054",
            "telephone_number": "334-285-5970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE HOSPICE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-05",
        "last_updated": "2012-01-05",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "505-821-3355",
        "authorized_official_credential": "J.D."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AL",
            "license": "01-1579PSL",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PIC1579EPSL",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Countryside Hospice-Prattville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Millbrook, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; 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.