| Organization Name: | COUNTRYSIDE ADULT FAMILY CARE HOME |
| NPI Number: | 1083936835 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NANCY TAPEC ATIENZA (ADMINISTRATOR) |
| Mailing Address: | 1334 Long Plains Road Buxton |
| State: | ME US |
| Postal Code: | 04093 |
| Phone Number: | 2079295787 |
| Fax Number: | |
| NPI Enumeration Date: | 02/22/2010 |
| NPI Last Update Date: | 02/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | ALLS3163 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |