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General NPI Number Information
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NPI Number | 1437266558
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Entity Type | Organization
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Legal Business Name | COUNTRY ESTATES NURSING, L.L.C.
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 1200 SUFFIELD ST
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City | AGAWAM
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State | MA
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Zip | 01001-2933
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Country | US
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Telephone | 413-789-2200
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Fax | 413-789-2269
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Provider Business Mailing Address
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Address Line | 680 S 4TH ST # KH-2
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City | LOUISVILLE
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State | KY
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Zip | 40202-2407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | MS. MARILYN WEAVER
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Credential |
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Telephone | 502-596-7563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0967
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License Number State | MA
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