1386705275 NPI number — COOPERS MILLS NURSING HOME, INC.

Table of content: (NPI 1386705275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386705275 NPI number — COOPERS MILLS NURSING HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOPERS MILLS NURSING HOME, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COUNTRY MANOR
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386705275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
179 LISBON ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04240-7248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-786-3554
Provider Business Mailing Address Fax Number:
207-786-8507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 MAIN STREET
Provider Second Line Business Practice Location Address:
BOX 209
Provider Business Practice Location Address City Name:
COOPERS MILLS
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-549-7471
Provider Business Practice Location Address Fax Number:
207-549-3617
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CYR
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
207-786-3554

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2004 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 018204 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com