Organization
COUNTRYSIDE LIVING & ELDERY HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM KEITH FLEENOR (OWNER)
(937) 875-0490
Entity
Organization
Contact information
Practice address
307 BEECHGROVE DR, ENGLEWOOD, OH 45322-1105
(937) 432-9870
(937) 432-9871
Mailing address
307 BEECHGROVE DR, ENGLEWOOD, OH 45322-1105
(937) 432-9870
(937) 432-9871
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
03/15/2022
Last updated
03/15/2022
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