COUNTRYSIDE HOSPICE CARE INC NPI 1790723211

NPI Information

NPI: 1790723211
Provider Name: COUNTRYSIDE HOSPICE CARE INC

Doing Business As: SOLAMORE HOSPICE JACKSONVILLE

Classification: Hospice Care, Community Based - 251G00000X
Entity Type: Organization
Address:
320 BRANSCOMB DR SW
SUITE D
JACKSONVILLE, AL
ZIP 36265
Phone: (256) 235-2999
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COUNTRYSIDE HOSPICE CARE INC is a hospice care community based in Jacksonville, AL. COUNTRYSIDE HOSPICE CARE INC NPI is 1790723211. The provider is registered as an organization entity type.
The provider Is Doing Business As Solamore Hospice Jacksonville.

The provider's business location address is:

320 BRANSCOMB DR SW
SUITE D
JACKSONVILLE, AL
ZIP 36265
Phone: (256) 235-2999
Fax: (256) 782-3590

The provider's authorized official is Glen Cavallo .
The authorized official title is Sr. Vp Of Operations and has the following contact phone number (479) 996-5900.

The enumeration date for this NPI number is 6/4/2006 and was last updated on 8/3/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251G00000X	Hospice Care, Community Based				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	011579	MEDICARE ID-TYPE UNSPECIFIED	ALABAMA
2	PIC1579E	MEDICAID	ALABAMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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