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Organization

COOPERSTOWN MEDICAL CENTER

Active
Parent organization
COOPERSTOWN MEDICAL CENTER
Other names
Cooperstown Medical Center Nursing Home
Organization subpart
Yes

Provider details

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

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1012A
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1107
BLUE CROSS BLUE SHIELD ND
ND
05
30095
ND
Enumeration date
09/29/2006
Last updated
05/14/2008
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