Atrium Countryside LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AH800236748 Issued in MI

Legal business name

ATRIUM COUNTRYSIDE LLC

Doing business as

Countryside Nursing and Rehabilitation Community

Practice address

120 Baseline Rd
South Haven, MI 49090-1037

Phone

(269) 637-8411

Fax

(269) 637-8460

NPI assigned

Jul 11, 2005

Organization subpart

No

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

Authorized official

Name

Dennis Lockhart

Title

Chief Accounting Officer

Phone

(614) 416-0600

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Countryside Nursing and Rehabilitation Community Doing business as

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392249600000",
    "number": "1497753834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 HAKES DR",
            "address_2": "SUITE 600",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494415574",
            "telephone_number": "231-799-6870",
            "fax_number": "231-799-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 BASELINE RD",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490901037",
            "telephone_number": "269-637-8411",
            "fax_number": "269-637-8460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATRIUM COUNTRYSIDE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-11",
        "last_updated": "2014-02-13",
        "status": "A",
        "authorized_official_last_name": "LOCKHART",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "614-416-0600"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MI",
            "license": "AH800236748",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "80-4050",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER CODE",
            "identifier": "S 9517",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60 4191457",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Countryside Nursing and Rehabilitation Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jasmin Alexander, BSN, RN
• Mitchel M Allard, MD
• Richard John Allen, M.D.
• Teresa Ansinn, ANP
• Brook Antonson, OTR/L
• Atrium South Haven LLC (South Haven Nursing and Rehabilitation Community)
• Alice Marie Bacak, O.D.
• John W Baker, D.D.S.
• Linda Lu Baker, LMSW
• Nancy Joan Baker, RN

• Assisted Living Facility in South Haven, MI
• Providers in South Haven, MI by specialty
• Assisted Living Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2014; 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.