# COUNTRYSIDE HOME

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

## Provider details

- **NPI number:** 1902881022
- **Authorized official:** MRS. LINDA ANDERSON ADMINISTRATOR (ADMINISTRATOR)
- **Authorized official phone:** (402) 454-3373

## Contact information

- **Practice address:** 703 N MAIN ST, MADISON, NE 68748-6009
- **Practice address phone:** (402) 454-3373
- **Practice address fax:** (402) 454-6509
- **Mailing address:** 703 N MAIN ST, MADISON, NE 68748-6009
- **Mailing address phone:** (402) 454-3373
- **Mailing address fax:** (402) 454-6509

## Taxonomy

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

## Other

- **Enumeration date:** 12/13/2005
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0637150001 | MEDICARE DME | NE |