{"npi":"1790723211","type":"NPI-2","status":"active","name":{"display":"Countryside Hospice Care INC","other":[],"organization_name":"COUNTRYSIDE HOSPICE CARE INC","authorised_official":"Glen Cavallo"},"specialty":{"primary_taxonomy":"251G00000X","primary_taxonomy_description":"Community Based Hospice Care Agency","slug":"community-based-hospice-care-agency","schema_org_specialty":null,"all":[{"code":"251G00000X","description":"Community Based Hospice Care Agency","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"320 BRANSCOMB DR SW","city":"JACKSONVILLE","state":"AL","postal_code":"36265","country_code":"US","street_2":"SUITE D","phone":"2562352999","fax":"2567823590"},{"purpose":"MAILING","street_1":"101 SUN AVE NE","city":"ALBUQUERQUE","state":"NM","postal_code":"871094373","country_code":"US","phone":"5054685604","fax":"5054684681"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"PIC1579E","state":"AL","issuer":null}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2006-06-04","last_updated":"2011-08-03","_meta":{"source":"NPPES","snapshot_date":"2011-08-03","doc_url":"https://findmynpi.com/api"}}