Provider Demographics
NPI:1659377869
Name:COOS COUNTY NURSING HOME
Entity Type:Organization
Organization Name:COOS COUNTY NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:603-752-2343
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-0416
Mailing Address - Country:US
Mailing Address - Phone:603-752-2343
Mailing Address - Fax:603-752-4773
Practice Address - Street 1:364 CATES HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-1554
Practice Address - Country:US
Practice Address - Phone:603-752-2343
Practice Address - Fax:603-752-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00636313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80547244Medicaid