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NPI Code Detail

MEDICARE: 1200 SUFFIELD STREET OPERATOR LLC

MEDICARE: 1200 SUFFIELD STREET OPERATOR LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityMA

General Provider Information

NPI Number : 1437675527
Entity Type Code : Organization
Provider Name (Legal Business Name) : 1200 SUFFIELD STREET OPERATOR LLC
Provider Business Mailing Address
First Line : 1200 SUFFIELD ST
Second Line :
City : AGAWAM
State : MA
Zip : 01001-2933
Country : US
Telephone Number : 413-789-2200
Fax Number :
Provider Business Practice Location Address
First Line : 1200 SUFFIELD ST
Second Line :
City : AGAWAM
State : MA
Zip : 01001-2933
Country : US
Telephone Number : 413-789-2200
Fax Number :
Authorized Official
Title or Position : CFO
Name : WILLIAM H STEPHAN
Credential :
Telephone Number : 617-943-7747
Provider Enumeration Date : 08/21/2017
Last Update Date : 07/21/2022

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Directions to “1200 SUFFIELD STREET OPERATOR LLC ” Practice Location

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