Country Aire Opco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

COUNTRY AIRE OPCO, LLC

Practice address

18540 State Highway 16
Lewistown, MO 63452-2111

Phone

(573) 215-2216

NPI assigned

Dec 16, 2018

Organization subpart

No

Name

Sam Stern

Title

Cfo

Phone

(877) 567-0402

• Country Aire Retirement Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 16, 2018.

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544918400000",
    "number": "1376014423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14C 53RD ST STE 220",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112322644",
            "telephone_number": "877-567-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18540 STATE HIGHWAY 16",
            "city": "LEWISTOWN",
            "state": "MO",
            "postal_code": "634522111",
            "telephone_number": "573-215-2216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY AIRE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2018-12-16",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "877-567-0402"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Aire Retirement Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anita Lyn Arnold, FNP-C
• Penny Elizabeth Buening, APRN
• Karen Joy Abando Cordova
• Country Aire Healthcare LLC
• Country Aire Operations Management LLC
• Deaconess Long Term Care of Missouri, Inc.
• Michelle Ebeling, M.A., CCC-SLP
• GX2 LLC
• Tanya Lee Jones, MSW

• All providers in Lewistown, MO
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2018; 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.