Organization
COUNTRYSIDE HEALTH SERVICES, LLC
Active
Other names
Countryside Estates, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ERIC ROGERS (MEMBER)
(918) 404-3443
Entity
Organization
Contact information
Practice address
HIGHWAY 64 EAST, WARNER, OK 74469-0749
(918) 463-5143
(918) 463-5144
Mailing address
PO BOX 749, WARNER, OK 74469-0749
(918) 463-5143
(918) 463-5144
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH51025102
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200073790A
—
OK
Enumeration date
08/16/2006
Last updated
01/08/2026
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