Organization
COUNTRYSIDE HOSPICE CARE INC
Active
Parent organization
COUNTRYSIDE HOSPICE CARE INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COUNTRYSIDE HOSPICE CARE INC
Authorized official
MS. NANCY C JAKUS BSN MBA RN (PRESIDENT CEO)
(256) 231-9190
Entity
Organization
Contact information
Practice address
955 S THREE NOTCH ST, ANDALUSIA, AL 36420-5231
(334) 222-7048
(334) 427-7246
Mailing address
1021 NOBLE ST, SUITE 207, ANNISTON, AL 36201-4607
(256) 231-9190
(256) 231-9190
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
11636
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11636
ALABAMA HOSPICE LICENSE
AL
05
—
PIC1547E
—
AL
Enumeration date
06/03/2006
Last updated
05/20/2008
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