Countryside Haven Assisted Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL5305 Issued in FL

Legal business name

COUNTRYSIDE HAVEN ASSISTED LIVING

Practice address

6960 County Road 95
Palm Harbor, FL 34684-4403

Phone

(727) 786-8461

Fax

(727) 784-0425

NPI assigned

Jan 9, 2017

Organization subpart

Yes

Parent organization

COUNTRYSIDE HAVEN ASSISTED LIVING LLCAs reported in NPPES

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

Authorized official

Name

Kathy Coogan

Title

Owner

Phone

(727) 534-6766

Specialties & licenses 1

Addresses

Part of

Countryside Haven Assisted Living

Locations

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483920000000",
    "number": "1396281887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6960 COUNTY ROAD 95",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346844403",
            "telephone_number": "727-786-8461",
            "fax_number": "727-784-0425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6960 COUNTY ROAD 95",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346844403",
            "telephone_number": "727-786-8461",
            "fax_number": "727-784-0425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE HAVEN ASSISTED LIVING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTRYSIDE HAVEN ASSISTED LIVING LLC",
        "enumeration_date": "2017-01-09",
        "last_updated": "2017-01-09",
        "status": "A",
        "authorized_official_last_name": "COOGAN",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-534-6766"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL5305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cosmetic Medicine Enterprises Inc
• Joseph Costello
• Mary Kathryn Costello, DPT
• Counseling Options LLC
• Countryside Blvd Opco LLC (Aviata at Countryside)
• Countryside Health Care Associates LLC (Countryside Rehab and Healthcare Center)
• Craig Cowart, M.D.
• Joseph Cox
• Katie Craigie
• Sherri L. Crawford, ARNP

• Assisted Living Facility in Palm Harbor, FL
• Providers in Palm Harbor, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; 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.