Organization
COUNTRYSIDE MANOR NURSING AND REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAYLEY WILLIAMS (ATTORNEY)
(216) 706-3936
Entity
Organization
Contact information
Practice address
1865 COUNTRYSIDE DR, FREMONT, OH 43420-8748
(419) 334-2602
(419) 344-6287
Mailing address
15 AMERICA AVE UNIT 304, LAKEWOOD, NJ 08701-4582
(513) 487-7479
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2362N
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2362N
LICENSURE
OH
Enumeration date
07/17/2018
Last updated
07/17/2018
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