Organization
COUNTRYSIDE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA ANDERSON ADMINISTRATOR (ADMINISTRATOR)
(402) 454-3373
Entity
Organization
Contact information
Practice address
703 N MAIN ST, MADISON, NE 68748-6009
(402) 454-3373
(402) 454-6509
Mailing address
703 N MAIN ST, MADISON, NE 68748-6009
(402) 454-3373
(402) 454-6509
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0637150001
MEDICARE DME
NE
Enumeration date
12/13/2005
Last updated
07/21/2022
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