# COUNTRYSIDE HOME

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

## Provider details

- **NPI number:** 1598893869
- **Authorized official:** MRS. CHANNITY MARIE FARLEY REGISTEREDNURSE (OWNER OPERATOR)
- **Authorized official phone:** (620) 326-8749

## Contact information

- **Practice address:** 122 S COUNTRYSIDE LN, WELLINGTON, KS 67152-8077
- **Practice address phone:** (620) 326-8749
- **Practice address fax:** (620) 326-2254
- **Mailing address:** 122 S COUNTRYSIDE LN, WELLINGTON, KS 67152-8077
- **Mailing address phone:** (620) 326-8749
- **Mailing address fax:** (620) 326-2254

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | B096014 | KS | Yes |

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 07/14/2008