COUNTRYSIDE MANOR LLC (NPI# 1275673642) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275673642 |
| Entity Type | Organization |
| Organization Name | COUNTRYSIDE MANOR LLC |
| Other Organization Name | COUNTRYSIDE MANOR |
| Practice Address |
300 S Thompson Rd Lamar AR 72846-9423 |
| Practice Telephone | 4797542052 |
| Practice Fax Number | 4797545745 |
| Mailing Telephone | 4797542052 |
| Mailing Fax Number | 4797545745 |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2008-02-19 |
| Authorized Official Name | JUSTIN PRICE (MEMBER) |
| Authorized Official Telephone | 9189679285 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | AR | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Countryside Manor | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144862376 | Countryside Manor LLC | Nursing Care | 1415 E Us Highway 54, Vandalia, MO 63382-2908 | 2019-10-09 |
| Street Address |
300 S THOMPSON RD |
| City | LAMAR |
| State | AR |
| Zip Code | 72846-9423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063724912 | Alternative Opportunities | Community/Behavioral Health | 1000 E Main, Lamar, AR 72846 | 2010-07-08 |
| 1447460993 | Sallie M Hampton | Nurse Practitioner | 635 Childers Street, Lamar, AR 72846 | 2007-05-23 |
| 1265919708 | Sarah Joy Cook | Nurse Practitioner | 291 W Main St, Lamar, AR 72846 | 2018-07-27 |
| 1073004891 | Access Medical Clinic Arkansas LLC | Family Medicine | 291 W Main St, Lamar, AR 72846 | 2018-05-29 |
| 1720509664 | Dana West | Counselor | 1000 E Main St, Lamar, AR 72846-7401 | 2017-06-30 |
| 1932551983 | Jeena Riddell | Counselor | 1000 E Main St, Lamar, AR 72846-7401 | 2016-07-01 |
| 1912356890 | Robert Washburn | Counselor | 1000 E Main St, Lamar, AR 72846-7401 | 2016-06-10 |
| 1619344967 | Logan White | Counselor | 1000 E Main St, Lamar, AR 72846-7401 | 2015-08-21 |
| 1356734628 | Heather Griggs | Counselor | 1000 E Main St, Lamar, AR 72846-7401 | 2015-03-11 |
| 1346661303 | Thomas Williams | Counselor | 1000 E Main St, Lamar, AR 72846-7401 | 2013-12-18 |
| Find all providers in zip 72846 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447659669 | Parkway Health Center, Inc. | Nursing Facility/Intermediate Care Facility | 14324 Chenal Pkwy, Little Rock, AR 72211-5805 | 2014-08-14 |
| 1093138059 | Little River Nursing and Rehab | Nursing Facility/Intermediate Care Facility | 162 Hwy 32-2a, Ashdown, AR 71822-8689 | 2014-01-28 |
| 1295071322 | Courtney Bickerstaff Apn,pllc | Nursing Facility/Intermediate Care Facility | 1309 Ashlea Place Dr, Bryant, AR 72022-9159 | 2012-12-18 |
| 1992014930 | Jane Ellen Phillips Apn Pllc | Nursing Facility/Intermediate Care Facility | 511 Farr Shores Dr, Hot Springs, AR 71913-9622 | 2010-09-24 |
| 1639480049 | Smith Drug Company | Nursing Facility/Intermediate Care Facility | 1104 Jones Rd, Paragould, AR 72450-7579 | 2010-06-30 |
| 1760627640 | Cavhs | Nursing Facility/Intermediate Care Facility | 2220 Ft Roots Drive, North Little Rock, AR 72114-1706 | 2008-12-08 |
| 1023283884 | A & C Fairways and Greenns Inc. | Nursing Facility/Intermediate Care Facility | 106 No. Third St., Marmaduke, AR 72443 | 2008-04-23 |
| 1568680742 | David E. Puryear Center | Nursing Facility/Intermediate Care Facility | 2806 Fox Meadow Ln, Jonesboro, AR 72404-9346 | 2007-04-23 |
| 1760520936 | Greenhurst, Inc. | Nursing Facility/Intermediate Care Facility | 226 Skyler Dr, Pob 458, Charleston, AR 72933-9337 | 2007-02-01 |
| 1851440309 | Stoneridge Health and Rehab Center | Nursing Facility/Intermediate Care Facility | 4017 Franklin, College Station, AR 72053 | 2007-01-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.