Provider Demographics
NPI:1457340069
Name:COYNE MANAGEMENT, L.L.C.
Entity Type:Organization
Organization Name:COYNE MANAGEMENT, L.L.C.
Other - Org Name:COYNE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-273-4002
Mailing Address - Street 1:56 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1737
Mailing Address - Country:US
Mailing Address - Phone:781-871-0555
Mailing Address - Fax:781-871-1832
Practice Address - Street 1:56 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-1737
Practice Address - Country:US
Practice Address - Phone:781-871-0555
Practice Address - Fax:781-871-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0609314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0923273Medicaid
MA670631OtherSECURE HORIZON PROVIDER
MA670631OtherSECURE HORIZON PROVIDER