Organization
COUNTRYSIDE CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN FRIEDMAN (CFO)
(845) 414-3300
Entity
Organization
Contact information
Practice address
400 W GRANT ST, MACOMB, IL 61455-2867
(309) 837-2386
(309) 836-9191
Mailing address
7B MEDICAL PARK DR, POMONA, NY 10970-3516
(845) 414-3300
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
09/18/2024
Last updated
09/18/2024
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