MEDICARE: COOS COUNTY NURSING HOME

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
1	313M00000X	Nursing Facility/Intermediate Care Facility	00636	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659377869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOS COUNTY NURSING HOME

Provider Business Mailing Address
First Line	:	PO BOX 416
Second Line	:
City	:	BERLIN
State	:	NH
Zip	:	03570-0416
Country	:	US
Telephone Number	:	603-752-2343
Fax Number	:	603-752-4773

Provider Business Practice Location Address
First Line	:	364 CATES HILL RD
Second Line	:
City	:	BERLIN
State	:	NH
Zip	:	03570-1554
Country	:	US
Telephone Number	:	603-752-2343
Fax Number	:	603-752-4773

Authorized Official
Title or Position	:	NURSING HOME ADMINISTRATOR
Name	:	MS. JEANNETTE MORNEAU
Credential	:	NHA
Telephone Number	:	603-752-2343

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/06/2008

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Directions to “COOS COUNTY NURSING HOME ” Practice Location

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