National Provider Identifier Database

COUNTRYSIDE HOSPICE CARE INC
Hospice Care, Community Based


Contact Information

COUNTRYSIDE HOSPICE CARE INC
320 BRANSCOMB DR SW
SUITE D
JACKSONVILLE, AL36265
Phone: 256-235-2999
Fax: 256-782-3590
Website:
Specialty Taxonomy Code
* Hospice Care, Community Based 251G00000X

* Indicates primary specialty

NPI Profile & details for COUNTRYSIDE HOSPICE CARE INC

NPI Number 1790723211
Legal business name
LBN
COUNTRYSIDE HOSPICE CARE INC
Authorized official GLEN CAVALLO - (SR. VP OF OPERATIONS)
Entity Organization
Organization subpart Yes
Enumeration date 06/04/2006
Last updated 08/03/2011 - About 15 years ago
Sole proprietor1 Not specified
Identifiers
  • AL Medicaid: PIC1579E

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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