1. Home
  2. Directory
  3. Arkansas
  4. Huntsville
  5. Assisted Living Facility
  6. NPI Profile

COUNTRYSIDE ASSISTED LIVING, LLC
NPI 1295028389
Assisted Living Facility in Huntsville, AR

Active since May 23, 2011CLIA 04D2195171 · Waiver
722 PHILLIPS PL, HUNTSVILLE, AR 72740(479) 738-1500(479) 738-1000 Get Directions Write a Review

NPPES record last updated: May 23, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Countryside Assisted Living, Llc NPPES

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

COUNTRYSIDE ASSISTED LIVING, LLC (NPI 1295028389) is a healthcare organization registered as an assisted living facility in Huntsville, Arkansas and active in the NPI registry since May 2011. The organization holds a CLIA Waiver certificate valid through October 6, 2026 and lists Tara H Box, Administrator, as its authorized official.

NPPES Registry Identity

NPI1295028389
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameCOUNTRYSIDE ASSISTED LIVING, LLC
Location Address722 PHILLIPS PLHuntsville, AR 72740-9517
Mailing Address722 Phillips PlHuntsville, AR 72740-9517 · (479) 738-1500 · Fax (479) 738-1000
Phone(479) 738-1500
Fax(479) 738-1000
Organization SubpartNo
Authorized OfficialTara H BoxAdministrator · (479) 738-1500
Enumeration DateMay 23, 2011
✔ NPI 1295028389 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in AR · 037
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.
722 PHILLIPS PL, Huntsville, AR 72740
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 04D2195171

Countryside Assisted Living · Huntsville, AR
Active · expires Oct 6, 2026
CLIA Number04D2195171
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 7, 2024
Certificate Expiration DateOctober 6, 2026
Laboratory DirectorDr. Ivan H. Box
Laboratory Phone(479) 738-1500
Laboratory LocationCountryside Assisted Living722 Phillips Place, Huntsville, AR 72740
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

TULASI BOCHULA
Physical Therapist
722 PHILLIPS PL
HUNTSVILLE, AR 72740
Madison County (479) 420-7846
COUNTRYSIDE HEALTHCARE, INC.
Assisted Living Facility
722 PHILLIPS PL
HUNTSVILLE, AR 72740
Madison County (479) 738-1500
MICAH ADAMS
Physical Therapist
722 PHILLIPS PL
HUNTSVILLE, AR 72740
Madison County (479) 738-1500

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 Assisted Living, LLC's NPI number?

The NPI number for Countryside Assisted Living, LLC is 1295028389. It was assigned to this organization in the NPPES registry on May 23, 2011.

Where is Countryside Assisted Living, LLC located?

Countryside Assisted Living, LLC is located at 722 Phillips Pl, Huntsville, AR 72740. The listed phone number is (479) 738-1500.

What is Countryside Assisted Living, LLC's specialty?

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

Does Countryside Assisted Living, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 04D2195171) is associated with this NPI, valid through October 6, 2026. 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 Assisted Living, LLC was last updated on May 23, 2011. 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.