Countryside Health Care Associates LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF11060962 Issued in FL

Legal business name

COUNTRYSIDE HEALTH CARE ASSOCIATES LLC

Doing business as

Countryside Rehab and Healthcare Center

Practice address

3825 Countryside Blvd N
Palm Harbor, FL 34684-4928

Phone

(727) 784-2848

Fax

(727) 781-1402

NPI assigned

May 25, 2006

Organization subpart

No

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

Authorized official

Name

Sandra A. Ryczek

Title

Manager

Phone

(727) 784-2848

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Countryside Rehab and Healthcare Center Doing business as

Locations

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343865600000",
    "number": "1396791349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3825 COUNTRYSIDE BLVD N",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346844928",
            "telephone_number": "727-784-2848",
            "fax_number": "727-781-1402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3825 COUNTRYSIDE BLVD N",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346844928",
            "telephone_number": "727-784-2848",
            "fax_number": "727-781-1402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE HEALTH CARE ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2012-08-02",
        "status": "A",
        "authorized_official_last_name": "RYCZEK",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "727-784-2848"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF11060962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025211500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Countryside Rehab and Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph Costello
• Mary Kathryn Costello, DPT
• Counseling Options LLC
• Countryside Blvd Opco LLC
• Countryside Haven Assisted Living
• Craig Cowart, M.D.
• Joseph Cox
• Katie Craigie
• Sherri L. Crawford, ARNP
• Krista Anne Creed

• Skilled Nursing Facility in Palm Harbor, FL
• Providers in Palm Harbor, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.