Organization
COUNTRYSIDE HOSPICE CARE, INC.
Active
Other names
Countryside Hospice-Prattville
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG J.D. (CORPORATE SECRETARY)
(505) 821-3355
Entity
Organization
Contact information
Practice address
5300 OAK TREE ROAD, SUITE B AND C, MILLBROOK, AL 36054
(334) 285-5970
Mailing address
18831 VON KARMAN BLVD., SUITE 400, IRVINE, CA 92612-1533
(949) 255-7129
(505) 468-9250
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
01-1579PSL
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PIC1579EPSL
—
AL
Enumeration date
01/05/2012
Last updated
01/05/2012
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