Healthcare Provider Details

I. General information

NPI: 1497731335
Provider Name (Legal Business Name): KOPSACK ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 VIRGINIA AVE
ROCHESTER PA
15074-1723
US

IV. Provider business mailing address

174 VIRGINIA AVE
ROCHESTER PA
15074-1723
US

V. Phone/Fax

Practice location:
  • Phone: 724-775-6400
  • Fax: 724-775-4386
Mailing address:
  • Phone: 724-775-6400
  • Fax: 724-775-4386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number180902
License Number StatePA

VIII. Authorized Official

Name: MR. NATHAN J KOPSACK
Title or Position: VICE PRESIDENT
Credential:
Phone: 724-775-6400