COUNTRYSIDE HOME, LLC is an assisted living facility in Lebanon, MO. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. COUNTRYSIDE HOME, LLC NPI is 1043520133. The provider is registered as an organization entity type.
The provider's business location address is:
24499 PARK DR
LEBANON, MO
ZIP 65536-843
Phone: (417) 532-7418
Fax: (417) 532-9359
The provider's authorized official is Mary Kay Howlett .
The authorized official title is Owner/administrator and has the following contact phone number (417) 532-7418.
The CLIA number assigned to this NPI record is 26D0970221 - other with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 10/7/2010 and was last updated on 10/7/2010.