Organization
COUNTRYSIDE CARE CENTRE LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CHARLES BRAUN (CONTROLLER)
(847) 583-0100
Entity
Organization
Contact information
Practice address
2330 W GALENA BLVD, AURORA, IL 60506-4246
(630) 896-4686
(630) 896-7868
Mailing address
2330 W GALENA BLVD, AURORA, IL 60506-4246
(630) 896-4686
(630) 896-7868
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
40931
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40931
IDPH LICENSE NUMBER
IL
01
—
6002174
IDPH FACILITY NUMBER
IL
Enumeration date
12/20/2005
Last updated
02/20/2012
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