Countryside Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

B096014 Issued in KS

Legal business name

COUNTRYSIDE HOME

Practice address

122 S Countryside LN
Wellington, KS 67152-8077

Phone

(620) 326-8749

Fax

(620) 326-2254

NPI assigned

Mar 1, 2007

Last updated

Jul 14, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Channity Marie Farley, REGISTEREDNURSE

Title

Owner Operator

Phone

(620) 326-8749

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1598893869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 S COUNTRYSIDE LN",
            "city": "WELLINGTON",
            "state": "KS",
            "postal_code": "671528077",
            "telephone_number": "620-326-8749",
            "fax_number": "620-326-2254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 S COUNTRYSIDE LN",
            "city": "WELLINGTON",
            "state": "KS",
            "postal_code": "671528077",
            "telephone_number": "620-326-8749",
            "fax_number": "620-326-2254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "FARLEY",
        "authorized_official_first_name": "CHANNITY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER OPERATOR",
        "authorized_official_telephone_number": "620-326-8749",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "REGISTEREDNURSE"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "KS",
            "license": "B096014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cancer Center of Kansas, P.a.
• Cep America - Kansas LLC
• Cherished Friends LLC
• City of Wellington
• Dawnell Linn Cohen, LAC 510
• County of Sumner (Sumner County Health Department)
• County of Sumner
• County of Sumner (Sumner County Health Department)
• Evan Crenshaw
• Isaac Miguel Cruz, LPC

• Adult Care Home Facility in Wellington, KS
• Providers in Wellington, KS by specialty
• Adult Care Home Facility in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.