1. Home
  2. Directory
  3. Missouri
  4. Lebanon
  5. Assisted Living Facility
  6. NPI Profile

COUNTRYSIDE HOME, LLC
NPI 1043520133
Assisted Living Facility in Lebanon, MO

Active since October 07, 2010CLIA 26D0970221 · Waiver
24499 PARK DR, LEBANON, MO 65536(417) 532-7418(417) 532-9359 Get Directions Write a Review

NPPES record last updated: October 7, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Countryside Home, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COUNTRYSIDE HOME, LLC (NPI 1043520133) is a healthcare organization registered as an assisted living facility in Lebanon, Missouri and active in the NPI registry since October 2010. The organization holds a CLIA Waiver certificate valid through February 6, 2028 and lists Mary Kay Howlett, Owner/administrator, as its authorized official.

NPPES Registry Identity

NPI1043520133
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameCOUNTRYSIDE HOME, LLC
Location Address24499 PARK DRLebanon, MO 65536-5843
Mailing Address24499 Park DrLebanon, MO 65536-5843 · (417) 532-7418 · Fax (417) 532-9359
Phone(417) 532-7418
Fax(417) 532-9359
Organization SubpartNo
Authorized OfficialMary Kay HowlettOwner/administrator · (417) 532-7418
Enumeration DateOctober 7, 2010
✔ NPI 1043520133 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
24499 PARK DR, Lebanon, MO 65536
Open in Google Maps ↗

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D0970221

Countryside Home, LLC · Lebanon, MO
Active · expires Feb 6, 2028
CLIA Number26D0970221
Laboratory TypeAssisted Living Facility
Certificate Effective DateFebruary 7, 2026
Certificate Expiration DateFebruary 6, 2028
Laboratory DirectorMary K. Howlett
Laboratory Phone(417) 532-7418
Laboratory LocationCountryside Home, LLC24499 Park Drive, Lebanon, MO 65536
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Countryside Home, LLC's NPI number?

The NPI number for Countryside Home, LLC is 1043520133. It was assigned to this organization in the NPPES registry on October 7, 2010.

Where is Countryside Home, LLC located?

Countryside Home, LLC is located at 24499 Park Dr, Lebanon, MO 65536. The listed phone number is (417) 532-7418.

What is Countryside Home, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Countryside Home, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D0970221) is associated with this NPI, valid through February 6, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Countryside Home, LLC was last updated on October 7, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.