Countryside Healthcare

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0036632 Issued in IL

Legal business name

COUNTRYSIDE HEALTHCARE

Practice address

1635 E 154TH St
Dolton, IL 60419-3001

Phone

(708) 841-9550

NPI assigned

Feb 21, 2007

Last updated

Aug 22, 2020By 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

Jennie Shan-Martin

Title

Controller

Phone

(847) 329-1555

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750426144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8320 SKOKIE BLVD",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600772545",
            "telephone_number": "847-329-1555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 E 154TH ST",
            "city": "DOLTON",
            "state": "IL",
            "postal_code": "604193001",
            "telephone_number": "708-841-9550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHAN-MARTIN",
        "authorized_official_first_name": "JENNIE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "847-329-1555"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0036632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Da'Shawn Colbert
• Amari Carnise Cole
• Erini Victoria Collaros, CCC-SLP
• Sophia M. Collaros, RPH
• Collins Investment Group LLC
• Countryside Nursing and Rehabilitation Center LLC
• Marcia Cutright, RN, LMT
• L'Kenya Sharron Dalcour
• Daley's Medical and Rental Supply
• Daleys Medical Transportation Inc (Bud's Ambulance Service)

• Skilled Nursing Facility in Dolton, IL
• Providers in Dolton, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.