| Organization Name: | COUNTRYWOOD ASSISTED LIVING & MEMORY CARE, LLC |
| NPI Number: | 1306041272 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN HOLTZ (CONTROLLER) |
| Mailing Address: | 1604 S 13th St Kingfisher |
| State: | OK US |
| Postal Code: | 737504619 |
| Phone Number: | 4053755232 |
| Fax Number: | 4053755830 |
| NPI Enumeration Date: | 06/19/2007 |
| NPI Last Update Date: | 05/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 305S00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Point of Service |
| Taxonomy Specialization: | |
| Taxonomy Definition: | This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |