COUNTRYSIDE MANOR HEALTHCARE CENTER (NPI# 1356300206) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356300206 |
| Entity Type | Organization |
| Organization Name | COUNTRYSIDE MANOR HEALTHCARE CENTER |
| Practice Address |
205 Marine Dr Anderson IN 46016-5937 |
| Practice Telephone | 7656494558 |
| Practice Fax Number | 7656411239 |
| Mailing Telephone | 7656494558 |
| Mailing Fax Number | 7656411239 |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. HERVEY LAWRENCE (ADMINISTRATOR) |
| Authorized Official Telephone | 7656494558 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3140N1450X |
Skilled Nursing Facility Specialization: Nursing Care, Pediatric |
Nursing & Custodial Care Facilities |
| Street Address |
205 MARINE DR |
| City | ANDERSON |
| State | IN |
| Zip Code | 46016-5937 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154829562 | Alisha Holman | Occupational Therapy Assistant | 205 Marine Dr, Anderson, IN 46016-5937 | 2018-01-31 |
| 1790006963 | Michelle Lee Sanford | Speech-Language Pathologist | 205 Marine Dr, Anderson, IN 46016-5937 | 2010-06-22 |
| 1366587966 | Riverview Hospital | Skilled Nursing Facility | 205 Marine Dr, Anderson, IN 46016-5937 | 2007-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639737356 | Alicia Borer | Optometrist | Macha Family Eye Care, 1537 S. Scatterfield Rd. Suite B, Anderson, IN 46016 | 2019-05-29 |
| 1740681469 | Melissa Dotson | Counselor | 2003 W 12th St, Anderson, IN 46016 | 2014-09-12 |
| 1811164239 | Vicky Lea Lawson | Technician/Technologist | 1503 Rev Jt Menifee Street, Anderson, IN 46016 | 2008-05-14 |
| 1023130812 | Robert L Loudermilk | Dentist | 226 West Historic Eighth Street, Anderson, IN 46016 | 2007-04-04 |
| 1215089297 | Chiropractic Works of Indiana Inc. | Chiropractor | 1541 S Scatterfield Rd, Suite A, Anderson, IN 46016 | 2007-01-18 |
| 1790851509 | Robert W Anderson | Internal Medicine | 2101 Jackson Street, Suite 111, Anderson, IN 46016 | 2006-11-27 |
| 1770668030 | Madison County Community Health Centers Inc | Family Medicine | 1547 Ohio Avenue, Anderson, IN 46016 | 2006-10-26 |
| 1437178035 | Teri L Schulz | Pediatrics | 2020 Meridian St Ste 320, Anderson, IN 46016 | 2006-07-18 |
| 1750331195 | Steven C. Kim | Urology | 141 W. 22nd St., Suite 203, Anderson, IN 46016 | 2006-05-10 |
| 1215905773 | Hazim Rimawi | Internal Medicine | 2020 Meridian St Ste 110, Anderson, IN 46016 | 2006-03-10 |
| Find all providers in zip 46016 | ||||
| Taxonomy Code | 3140N1450X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| Specialization | Nursing Care, Pediatric |
| A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437483344 | Hcr Manor Care | Skilled Nursing Facility | 5121 S Bancroft St, Indianapolis, IN 46237-1942 | 2009-09-24 |
| 1518182583 | Noblesville Schools | Skilled Nursing Facility | 1775 Field Dr, Noblesville, IN 46060-1744 | 2007-04-16 |
| 1801963053 | Hoosier Enterprises II, Inc. | Skilled Nursing Facility | 2325 S Miller St, Shelbyville, IN 46176-9350 | 2006-11-30 |
| 1316932874 | Putnam County Hospital | Skilled Nursing Facility | 1955 Vernon St, Wabash, IN 46992-4026 | 2005-09-12 |
| 1437357662 | Daviess County Hospital | Skilled Nursing Facility | 201 E Elm St, New Albany, IN 47150-3428 | 2007-07-10 |
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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.