# COUNTRYSIDE CENTER FOR REHABILITATION AND NURSING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Countryside Center for Rehabilitation and Nursing
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972003721
- **Authorized official:** MICK VUJANOVIC (CEO)
- **Authorized official phone:** (502) 667-8150

## Contact information

- **Practice address:** 47 MARGO AVE, BARDWELL, KY 42023-9005
- **Practice address phone:** (270) 628-5424
- **Mailing address:** 2100 CHEROKEE RIDGE WAY STE 100, LOUISVILLE, KY 40205-1600
- **Mailing address phone:** (502) 667-8150

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | KY | — |
| 314000000X | Skilled Nursing Facility | — | KY | Yes |
| 385H00000X | Respite Care | — | KY | — |

## Other

- **Enumeration date:** 02/19/2018
- **Last updated:** 10/09/2024