Coopers Mills Nursing Home, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2004 Issued in ME

Legal business name

COOPERS MILLS NURSING HOME, INC.

Doing business as

Country Manor

Practice address

132 Main Street
Box 209
Coopers Mills, ME 04341

Phone

(207) 549-7471

Fax

(207) 549-3617

NPI assigned

Dec 13, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Glen G Cyr

Title

VP of Finance

Phone

(207) 786-3554

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Manor Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386705275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 LISBON ST",
            "address_2": "2ND FLOOR",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042407248",
            "telephone_number": "207-786-3554",
            "fax_number": "207-786-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 MAIN STREET",
            "address_2": "BOX 209",
            "city": "COOPERS MILLS",
            "state": "ME",
            "postal_code": "04341",
            "telephone_number": "207-549-7471",
            "fax_number": "207-549-3617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOPERS MILLS NURSING HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CYR",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "207-786-3554",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ME",
            "license": "2004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "018204",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Judith Walker Day, LCSW
• Healthreach Community Health Centers (Sheepscot Valley Health Center)
• Shannon Lynn Hunt, PA-C
• Daniel J Keane, DPM
• Colin McCabe, FNP

• Skilled Nursing Facility in Coopers Mills, ME
• Providers in Coopers Mills, ME by specialty
• Skilled Nursing Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.