Countryside Acres Assisted Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

0013811 Issued in WI

Legal business name

COUNTRYSIDE ACRES ASSISTED LIVING

Practice address

5788 County Road C
Webster, WI 54893-8719

Phone

(715) 866-4411

Fax

(715) 866-4469

NPI assigned

May 1, 2012

Last updated

May 1, 2012By 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

Sara Jo Stadler, LPNNPI 1548528227

Title

Administrator

Phone

(715) 866-4411

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sara Jo Stadler, LPN

  • Licensed Practical Nurse
  • Webster, WI
  • NPI 1548528227
  NPD (past) Authorized official

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

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335830400000",
    "number": "1891053575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5788 COUNTY ROAD C",
            "city": "WEBSTER",
            "state": "WI",
            "postal_code": "548938719",
            "telephone_number": "715-866-4411",
            "fax_number": "715-866-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5788 COUNTY ROAD C",
            "city": "WEBSTER",
            "state": "WI",
            "postal_code": "548938719",
            "telephone_number": "715-866-4411",
            "fax_number": "715-866-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE ACRES ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-01",
        "last_updated": "2012-05-01",
        "status": "A",
        "authorized_official_last_name": "STADLER",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "715-866-4411",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WI",
            "license": "0013811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Dale Blowers, DC
• Dolores Brihn, RN
• Gaylen Terrill Brown, RN
• Carolina Calixto-Rosas, RN
• Cares in Motion Inc.
• Anna Crabtree, RN
• Kylie Cumber, APSW
• Julie Marie Dalsveen, LPN
• David Edward Detienne, RPH
• Kathleen Ann Dittmar, LPN

• Assisted Living Facility in Webster, WI
• Providers in Webster, WI by specialty
• Assisted Living Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; 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.