Organization Name: | COUNTRYSIDE HOSPICE CARE INC |
NPI Number: | 1790723211 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GLEN CAVALLO (SR. VP OF OPERATIONS) |
Mailing Address: | 320 Branscomb Dr Sw Suite D Jacksonville |
State: | AL US |
Postal Code: | 36265 |
Phone Number: | 2562352999 |
Fax Number: | 2567823590 |
NPI Enumeration Date: | 06/04/2006 |
NPI Last Update Date: | 08/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |