Provider Demographics
NPI:1790955581
Name:M&RLONG, INC
Entity Type:Organization
Organization Name:M&RLONG, INC
Other - Org Name:COUNTRYSIDE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSWITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-235-4040
Mailing Address - Street 1:385 S EISENHOWER ST
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-8266
Mailing Address - Country:US
Mailing Address - Phone:417-235-4040
Mailing Address - Fax:
Practice Address - Street 1:385 S EISENHOWER ST
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-8266
Practice Address - Country:US
Practice Address - Phone:417-235-4040
Practice Address - Fax:417-235-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility