Provider Demographics
NPI:1831171453
Name:COUNTRY CARE INC.
Entity type:Organization
Organization Name:COUNTRY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, COUNTRY CARE, INC
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, MBA, ADMIN
Authorized Official - Phone:913-773-5517
Mailing Address - Street 1:515 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:KS
Mailing Address - Zip Code:66020-9200
Mailing Address - Country:US
Mailing Address - Phone:913-773-5517
Mailing Address - Fax:913-773-5562
Practice Address - Street 1:515 DAWSON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:KS
Practice Address - Zip Code:66020-9200
Practice Address - Country:US
Practice Address - Phone:913-773-5517
Practice Address - Fax:913-773-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN052002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100109970AMedicaid
175411Medicare Oscar/Certification