Provider Demographics
NPI:1497731335
Name:KOPSACK ASSOCIATES, INC.
Entity Type:Organization
Organization Name:KOPSACK ASSOCIATES, INC.
Other - Org Name:ROCHESTER MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOPSACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-775-6400
Mailing Address - Street 1:174 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-1723
Mailing Address - Country:US
Mailing Address - Phone:724-775-6400
Mailing Address - Fax:724-775-4386
Practice Address - Street 1:174 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-1723
Practice Address - Country:US
Practice Address - Phone:724-775-6400
Practice Address - Fax:724-775-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA180902313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA494OtherHIGHMARK BCBS
PA494OtherHIGHMARK BCBS