| NPI | 1346806015 |
|---|---|
| Doing Business As | COUNTRYSIDE |
| Entity Type | Organization |
| Authorized Contact | TODD WILLIAMS NUNN President 919-922-4084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2020-02-09 |