Provider Demographics
NPI:1497447841
Name:COUNTRYSIDE TN REHAB LLC
Entity Type:Organization
Organization Name:COUNTRYSIDE TN REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NAFTALI
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-613-4386
Mailing Address - Street 1:3051 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-6189
Mailing Address - Country:US
Mailing Address - Phone:931-762-7518
Mailing Address - Fax:931-762-7873
Practice Address - Street 1:3051 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-6189
Practice Address - Country:US
Practice Address - Phone:931-762-7518
Practice Address - Fax:931-762-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility