# COOPERSTOWN MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COOPERSTOWN MEDICAL CENTER
- **Other names:** Cooperstown Medical Center Nursing Home
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1285726067
- **Legal business name:** COOPERSTOWN MEDICAL CENTER
- **Authorized official:** GREGORY STOMP RN, LNHA (ADMINISTRATOR/CEO)
- **Authorized official phone:** (701) 797-2221

## Contact information

- **Practice address:** 1200 ROBERTS AVE NE, COOPERSTOWN, ND 58425-7101
- **Practice address phone:** (701) 797-2221
- **Mailing address:** 1200 ROBERTS AVE NE, COOPERSTOWN, ND 58425-7101
- **Mailing address phone:** (701) 797-2221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 1012A | ND | Yes |

## Other

- **Enumeration date:** 09/29/2006
- **Last updated:** 05/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1107 | BLUE CROSS BLUE SHIELD ND | ND |
| 05 | — | 30095 | — | ND |