Provider Demographics
NPI:1518171578
Name:C AND M HEALTHCARE CORP.
Entity Type:Organization
Organization Name:C AND M HEALTHCARE CORP.
Other - Org Name:COUNTRYSIDE HAVEN ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARIDAD
Authorized Official - Middle Name:O
Authorized Official - Last Name:PE
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:727-786-8461
Mailing Address - Street 1:6960 COUNTY ROAD 95
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4403
Mailing Address - Country:US
Mailing Address - Phone:727-786-8461
Mailing Address - Fax:727-784-0425
Practice Address - Street 1:6960 COUNTY ROAD 95
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4403
Practice Address - Country:US
Practice Address - Phone:727-786-8461
Practice Address - Fax:727-784-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5305310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL682835300Medicaid