MEDICARE: 1561 COLD SPRING ROAD OPERATING COMPANY, 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
1	314000000X	Skilled Nursing Facility	0080	MA

General Provider Information

NPI Number	:	1699080010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1561 COLD SPRING ROAD OPERATING COMPANY, LLC

Provider Business Mailing Address
First Line	:	173 BRIDGE PLZ N
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-7575
Country	:	US
Telephone Number	:	201-242-4920
Fax Number	:

Provider Business Practice Location Address
First Line	:	1561 COLD SPRING RD
Second Line	:
City	:	WILLIAMSTOWN
State	:	MA
Zip	:	01267-2743
Country	:	US
Telephone Number	:	413-458-8127
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MS. ANNE H. STUART
Credential	:
Telephone Number	:	201-242-4920

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	08/10/2010

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