NPI 1043520133

Countryside Home, LLC

Organisation Assisted Living Facility Lebanon, MO

Practice location

Address: 24499 Park Dr, Lebanon, MO 65536-5843
Phone: (417) 532-7418
Fax: (417) 532-9359

Authorised official

Name: Mary Kay Howlett
Title: Owner/Administrator
Phone: (417) 532-7418

Registered specialties

Assisted Living Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310400000X

Other Assisted Living Facility providers in Missouri →

Registry record

NPI: 1043520133
Entity type: Organization
NPI issued: 7 Oct 2010
Record last updated: 7 Oct 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.