| Organization Name: | COUNTRYSIDE HOSPICE CARE INC |
| NPI Number: | 1275571259 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NANCY C JAKUS (PRESIDENT CEO) |
| Mailing Address: | 955 S Three Notch St Andalusia |
| State: | AL US |
| Postal Code: | 364205231 |
| Phone Number: | 3342227048 |
| Fax Number: | 3344277246 |
| NPI Enumeration Date: | 06/03/2006 |
| NPI Last Update Date: | 05/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | 11636 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |