# COUNTRYSIDE CONVALESCENT HOME LIMITED PARTNERSHIP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376537431
- **Authorized official:** STEVEN D TACK NHA (CEO)
- **Authorized official phone:** (724) 431-0770

## Contact information

- **Practice address:** 8221 LAMOR RD, MERCER, PA 16137-3163
- **Practice address phone:** (724) 431-0770
- **Practice address fax:** (724) 431-0764
- **Mailing address:** 8221 LAMOR RD, MERCER, PA 16137-3163
- **Mailing address phone:** (724) 431-0770
- **Mailing address fax:** (724) 431-0764

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 09/06/2005
- **Last updated:** 08/14/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0012990090001 | — | PA |
| 01 | — | 1121 | HIGHMARK BC | — |
| 01 | — | 1501006 | GATEWAY HP | PA |
| 01 | — | 263249 | HEALTH AMERICA | PA |
| 01 | — | 305354 | UPMC | — |