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Organization
COUNTRYSIDE CARE CENTER, INC.
Active
Organization
COUNTRYSIDE CARE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GANTON (ADMINISTRATOR)
(517) 787-4150
Entity
Organization
Contact information
Practice address
2121 ROBINSON RD, JACKSON, MI 49203-3658
(517) 787-4150
Mailing address
2121 ROBINSON RD, JACKSON, MI 49203-3658
(517) 787-4150
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
38-4180
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2153813
—
MI
Enumeration date
11/21/2006
Last updated
02/02/2023
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