Provider Demographics
NPI:1255044046
Name:STOUGHTON SENIOR LIVING LLC
Entity type:Organization
Organization Name:STOUGHTON SENIOR LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:COUGHENOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-891-6003
Mailing Address - Street 1:101 W BIG BEAVER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5255
Mailing Address - Country:US
Mailing Address - Phone:248-680-7180
Mailing Address - Fax:
Practice Address - Street 1:2121 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-6146
Practice Address - Country:US
Practice Address - Phone:248-680-7180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STOUGHTON SENIOR LIVING REAL ESTATE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-27
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility