| Organization Name: | COUNTRYSIDE HOSPICE CARE, INC. |
| NPI Number: | 1295005437 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL T. BERG (CORPORATE SECRETARY) |
| Mailing Address: | 5300 Oak Tree Road Suite B And C Millbrook |
| State: | AL US |
| Postal Code: | 36054 |
| Phone Number: | 3342855970 |
| Fax Number: | |
| NPI Enumeration Date: | 01/05/2012 |
| NPI Last Update Date: | 01/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | 01-1579PSL |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |