Organization
COUNTRYSIDE HOME, LLC
Active
Organization
COUNTRYSIDE HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY KAY HOWLETT (OWNER/ADMINISTRATOR)
(417) 532-7418
Entity
Organization
Contact information
Practice address
24499 PARK DR, LEBANON, MO 65536-5843
(417) 532-7418
(417) 532-9359
Mailing address
24499 PARK DR, LEBANON, MO 65536-5843
(417) 532-7418
(417) 532-9359
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
MO
Other
Enumeration date
10/07/2010
Last updated
10/07/2010
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