Provider Demographics
NPI:1639917198
Name:COUNTRYSIDE CONVALESCENT HOME LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:COUNTRYSIDE CONVALESCENT HOME LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKIVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-431-0770
Mailing Address - Street 1:612 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4363
Mailing Address - Country:US
Mailing Address - Phone:724-431-0770
Mailing Address - Fax:
Practice Address - Street 1:8221 LAMOR ROAD
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-3163
Practice Address - Country:US
Practice Address - Phone:724-458-9501
Practice Address - Fax:724-662-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility