Organization
ATRIUM COUNTRYSIDE LLC
Active
Other names
Countryside Nursing and Rehabilitation Community
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS LOCKHART (CHIEF ACCOUNTING OFFICER)
(614) 416-0600
Entity
Organization
Contact information
Practice address
120 BASELINE RD, SOUTH HAVEN, MI 49090-1037
(269) 637-8411
(269) 637-8460
Mailing address
5000 HAKES DR, SUITE 600, NORTON SHORES, MI 49441-5574
(231) 799-6870
(231) 799-0250
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AH800236748
MI
314000000X
Skilled Nursing Facility
80-4050
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60 4191457
—
MI
01
—
S 9517
BCBS PROVIDER CODE
MI
Enumeration date
07/11/2005
Last updated
02/13/2014
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