COUNTRYSIDE RETIREMENT HOME, INC.
NPI 1104825876
Nursing Facility/Intermediate Care Facility in Sioux City, IA

Q: What is Countryside Retirement Home Of Sioux City, Iowa's specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

Active since July 15, 2005

6120 MORNINGSIDE AVE, SIOUX CITY, IA 51106(712) 276-3000(712) 266-2167 Get Directions Write a Review

NPPES record last updated: September 11, 2009. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Countryside Retirement Home, Inc. NPPES

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

COUNTRYSIDE RETIREMENT HOME, INC. (NPI 1104825876) is a healthcare organization registered as a nursing facility/intermediate care facility in Sioux City, Iowa and active in the NPI registry since July 2005. The organization lists Debbie Menzenberg, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1104825876

Entity TypeOrganization

Primary Taxonomy313M00000X

Legal Business NameCOUNTRYSIDE RETIREMENT HOME OF SIOUX CITY, IOWA

Location Address6120 MORNINGSIDE AVESioux City, IA 51106-3943

Mailing Address6120 Morningside AveSioux City, IA 51106-3943 · (712) 276-3000 · Fax (712) 266-2167

Phone(712) 276-3000

Fax(712) 266-2167

Organization SubpartNo

Authorized OfficialDebbie MenzenbergExecutive Director · (712) 276-3000

Enumeration DateJuly 15, 2005

Last NPPES UpdateSeptember 11, 2009

✔ NPI 1104825876 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities

Taxonomy Code313M00000X

License✔ Licensed in IA · N-0370

Definition

An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

Also ListedCustodial Care FacilityTaxonomy 311Z00000X · License R-0370 (IA)

6120 MORNINGSIDE AVE, Sioux City, IA 51106

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Other Names 1

Doing Business AsCountryside Retirement Home, Inc.

Other Identifiers 2

Medicare ID-Type Unspecified165540IA · Provider Number

Medicaid0800300IA

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MELISSA ANN MILLARD

Physical Therapy Assistant