NPIMap

Organization Active NPI

Agawam North Operating LLC

Doing business as Agawam North Rehab and Nursing

  • Skilled Nursing Facility
  • Agawam, MA
National Provider Identifier
1649175449
Registry record updated Oct 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
AGAWAM NORTH OPERATING LLC
Doing business as
Agawam North Rehab and Nursing
Practice address
55 Cooper St
Agawam, MA 01001-2149
Phone
(413) 333-8131
NPI assigned
Oct 12, 2026
Last updated
Oct 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2026

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

Authorized official

Name
Nicholas Destefane
Title
Ceo
Phone
(314) 543-3800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

55 Cooper St
Agawam, MA 01001-2149

Mailing address

1869 Craig Park CT
Saint Louis, MO 63146-4122

Other names 1

  • Agawam North Rehab and Nursing Doing business as

NPI Registry JSON

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

{
    "created_epoch": "1791763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791763200000",
    "number": "1649175449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1869 CRAIG PARK CT",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631464122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 COOPER ST",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "010012149",
            "telephone_number": "413-333-8131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAWAM NORTH OPERATING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-12",
        "last_updated": "2026-10-12",
        "certification_date": "2026-10-12",
        "status": "A",
        "authorized_official_last_name": "DESTEFANE",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-543-3800"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Agawam North Rehab and Nursing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Agawam, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.