Countryside Assisted Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

037 Issued in AR

Legal business name

COUNTRYSIDE ASSISTED LIVING, LLC

Practice address

722 Phillips PL
Huntsville, AR 72740-9517

Phone

(479) 738-1500

Fax

(479) 738-1000

NPI assigned

May 23, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Tara H Box

Title

Administrator

Phone

(479) 738-1500

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1306108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306108800000",
    "number": "1295028389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 PHILLIPS PL",
            "city": "HUNTSVILLE",
            "state": "AR",
            "postal_code": "727409517",
            "telephone_number": "479-738-1500",
            "fax_number": "479-738-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 PHILLIPS PL",
            "city": "HUNTSVILLE",
            "state": "AR",
            "postal_code": "727409517",
            "telephone_number": "479-738-1500",
            "fax_number": "479-738-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE ASSISTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-23",
        "last_updated": "2011-05-23",
        "status": "A",
        "authorized_official_last_name": "BOX",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "479-738-1500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AR",
            "license": "037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila Jeanette Chapman, MHPP
• Mary Louise Child, MHPP
• Tony D Chism
• Charles Edward Coger, PD
• Edward Perry Cooper Jr., DMD
• Countryside Healthcare, Inc.
• County of Madison
• Tamra Lynn Cox, MSN, RN, NP-C
• Cierra K Creek
• Rita I Cruz-Collins, LCSW

• Assisted Living Facility in Huntsville, AR
• Providers in Huntsville, AR by specialty
• Assisted Living Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.