Countryside Hospice Care Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

COUNTRYSIDE HOSPICE CARE INC

Practice address

320 Branscomb Dr SW
Suite D
Jacksonville, AL 36265

Phone

(256) 235-2999

Fax

(256) 782-3590

NPI assigned

Jun 4, 2006

Organization subpart

Yes

Parent organization

SOLAMOR HOSPICEAs reported in NPPES

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

Authorized official

Name

Mr. Glen Cavallo

Title

Sr. VP of Operations

Phone

(479) 996-5900

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SolAmore Hospice Jacksonville Doing business as

Part of

Allegiance Hospice Group Inc

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312329600000",
    "number": "1790723211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUN AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094373",
            "telephone_number": "505-468-5604",
            "fax_number": "505-468-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 BRANSCOMB DR SW",
            "address_2": "SUITE D",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "36265",
            "telephone_number": "256-235-2999",
            "fax_number": "256-782-3590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE HOSPICE CARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOLAMOR HOSPICE",
        "enumeration_date": "2006-06-04",
        "last_updated": "2011-08-03",
        "status": "A",
        "authorized_official_last_name": "CAVALLO",
        "authorized_official_first_name": "GLEN",
        "authorized_official_title_or_position": "SR. VP OF OPERATIONS",
        "authorized_official_telephone_number": "479-996-5900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PIC1579E",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SolAmore Hospice Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Jennifer Coffman, CRNA
• Rhonda Tow Coker, NURSE PRACTITIONER-C
• Harsha Vihab Hai Cole, PA-C
• Jacob Norton Cole
• James Leon Colvin Jr., R.PH.
• Rebecca Desha Cox
• Crow Drug Inc
• Andra Cunningham
• Bruce Edward Cunningham, DMD
• T. David Cunningham Jr., LPC; NBCC

• Community Based Hospice Care Agency in Jacksonville, AL
• Providers in Jacksonville, AL by specialty
• Community Based Hospice Care Agency in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; 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.