Countryside Manor

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

0327 Issued in MO

Legal business name

COUNTRYSIDE MANOR

Practice address

1415 E US Highway 54
Vandalia, MO 63382-2908

Phone

(573) 594-6215

NPI assigned

Jun 6, 2007

Organization subpart

No

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

Authorized official

Name

Karen Kaye Harrower, LPN

Title

Director of Nursing

Phone

(573) 594-6215

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801099213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 E US HIGHWAY 54",
            "city": "VANDALIA",
            "state": "MO",
            "postal_code": "633822908",
            "telephone_number": "573-594-6215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 E US HIGHWAY 54",
            "city": "VANDALIA",
            "state": "MO",
            "postal_code": "633822908",
            "telephone_number": "573-594-6215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARROWER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "KAYE",
        "authorized_official_title_or_position": "DIRECTOR OF NURSING",
        "authorized_official_telephone_number": "573-594-6215",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "0327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle McGovern Bradshaw, D.O.
• Cole Chiropractic Center LLC
• Michael Robert Cole, CHIROPRACTOR
• Countryside Manor LLC
• Christina Dixon, AGNP-C
• Dr. Craig a. Long, D.D.S.
• Nicole Gibson
• Crisanto Gualberto, M.D.

• All providers in Vandalia, MO
• Assisted Living Facility in Missouri

• 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.