Organization
COUNTRYSIDE HOME CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GROVER (OWNER/ADMINISTRATOR)
(208) 756-4032
Entity
Organization
Contact information
Practice address
1213 MAIN ST, SALMON, ID 83467-4324
(208) 756-4032
(208) 756-6477
Mailing address
1213 MAIN ST, SALMON, ID 83467-4324
(208) 756-4032
(208) 756-6477
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
09/23/2005
Last updated
08/22/2020
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