Countryside Care Center, INC.
Skilled Nursing Facility in Jackson, MI. Organization (NPI-2).
NPI number1164597688
StatusActive
Last updated in NPPESFeb 2, 2023
Details
- NPI
- 1164597688
- Entity type
- Organization (NPI-2)
- Legal business name
- Countryside Care Center, INC.
- Organization subpart
- No
- Enumeration date
- Nov 21, 2006
- Certification date
- Feb 2, 2023
- Last updated
- Feb 2, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 314000000X | Skilled Nursing Facility | 38-4180 | MI | Yes |
Practice location
2121 Robinson RdJackson, MI 49203-3658
Phone 517-787-4150
Mailing address
2121 Robinson RdJackson, MI 49203-3658
Phone 517-787-4150
Authorized official
John Ganton
Administrator
5177874150
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