NPI | 1104825876 |
---|---|
Doing Business As | COUNTRYSIDE RETIREMENT HOME, INC. |
Entity Type | Organization |
Authorized Contact | DEBBIE MENZENBERG Executive Director 712-276-3000 |
Organization Subpart ? | No |
Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IA N-0370) |
Additional Taxonomies | 311Z00000X Custodial Care Facility (Licence: IA R-0370) |
Enumeration Date | 2005-07-15 |
Last Update Date | 2009-09-11 |