Countryside Healthcare, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

COUNTRYSIDE HEALTHCARE, INC.

Practice address

722 Phillips PL
Huntsville, AR 72740-9517

Phone

(479) 738-1500

NPI assigned

Jan 19, 2009

Organization subpart

No

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

Authorized official

Name

Tara Helen Box, BSBA

Title

Administrator

Phone

(479) 738-1500

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1232323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232323200000",
    "number": "1659518256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 PHILLIPS PL",
            "city": "HUNTSVILLE",
            "state": "AR",
            "postal_code": "727409517",
            "telephone_number": "479-738-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 PHILLIPS PL",
            "city": "HUNTSVILLE",
            "state": "AR",
            "postal_code": "727409517",
            "telephone_number": "479-738-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-19",
        "last_updated": "2009-01-19",
        "status": "A",
        "authorized_official_last_name": "BOX",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "HELEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "479-738-1500",
        "authorized_official_credential": "BSBA"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Louise Child, MHPP
• Tony D Chism
• Charles Edward Coger, PD
• Edward Perry Cooper Jr., DMD
• Countryside Assisted Living, LLC
• County of Madison
• Tamra Lynn Cox, MSN, RN, NP-C
• Cierra K Creek
• Rita I Cruz-Collins, LCSW
• Victoria Marie Deal, APRN, FNP-BC

• Assisted Living Facility in Huntsville, AR
• Providers in Huntsville, AR by specialty
• Assisted Living Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2009; 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.