Provider Demographics
NPI:1508853177
Name:COPLEY HEALTH CARE PARTNERSHIP
Entity Type:Organization
Organization Name:COPLEY HEALTH CARE PARTNERSHIP
Other - Org Name:COPLEY AT STOUGHTON NURSING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-341-2300
Mailing Address - Street 1:380 SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3430
Mailing Address - Country:US
Mailing Address - Phone:781-341-2300
Mailing Address - Fax:
Practice Address - Street 1:380 SUMNER ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072
Practice Address - Country:US
Practice Address - Phone:781-341-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0977314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0921955Medicaid
225653Medicare ID - Type Unspecified