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General NPI Number Information
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NPI Number | 1497731335
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Entity Type | Organization
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Legal Business Name | KOPSACK ASSOCIATES, INC.
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 174 VIRGINIA AVE
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City | ROCHESTER
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State | PA
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Zip | 15074-1723
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Country | US
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Telephone | 724-775-6400
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Fax | 724-775-4386
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Provider Business Mailing Address
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Address Line | 174 VIRGINIA AVE
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City | ROCHESTER
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State | PA
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Zip | 15074-1723
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Country | US
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Telephone | 724-775-6400
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Fax | 724-775-4386
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. NATHAN J KOPSACK
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Credential |
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Telephone | 724-775-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 180902
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License Number State | PA
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