Countryside Manor Healthcare Center

Primary specialty

Pediatric Skilled Nursing FacilityTaxonomy code 3140N1450X

Legal business name

COUNTRYSIDE MANOR HEALTHCARE CENTER

Practice address

205 Marine Dr
Anderson, IN 46016-5937

Phone

(765) 649-4558

Fax

(765) 641-1239

NPI assigned

Mar 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Hervey Lawrence

Title

Administrator

Phone

(765) 649-4558

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356300206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 MARINE DR",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460165937",
            "telephone_number": "765-649-4558",
            "fax_number": "765-641-1239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 MARINE DR",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460165937",
            "telephone_number": "765-649-4558",
            "fax_number": "765-641-1239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE MANOR HEALTHCARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "HERVEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "765-649-4558",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Cosman, PHARMD
• Jeff Cottrell
• Alexia Brenna Couch, RBT
• Coulter Martinez
• Riley Counceller
• Melissa Anne Cousins, FNP
• Patrick Cowger, LCSW
• Beth Anne Cox, LCSW
• Bonita I. Cox, MSW, LCSW
• Glendon Keith Cox, D.MIN.

• Pediatric Skilled Nursing Facility in Anderson, IN
• Providers in Anderson, IN by specialty
• Pediatric Skilled Nursing Facility in Indiana

• 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.