# COUNTRYSIDE RETIREMENT HOME OF SIOUX CITY, IOWA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Countryside Retirement Home, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104825876
- **Authorized official:** DEBBIE MENZENBERG (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (712) 276-3000

## Contact information

- **Practice address:** 6120 MORNINGSIDE AVE, SIOUX CITY, IA 51106-3943
- **Practice address phone:** (712) 276-3000
- **Practice address fax:** (712) 266-2167
- **Mailing address:** 6120 MORNINGSIDE AVE, SIOUX CITY, IA 51106-3943
- **Mailing address phone:** (712) 276-3000
- **Mailing address fax:** (712) 266-2167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311Z00000X | Custodial Care Facility | R-0370 | IA | — |
| 313M00000X | Nursing Facility/Intermediate Care Facility | N-0370 | IA | Yes |

## Other

- **Enumeration date:** 07/15/2005
- **Last updated:** 09/11/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0800300 | — | IA |