Organization
COOPERS MILLS NURSING HOME, INC.
Active
Other names
Country Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLEN G CYR (VP OF FINANCE)
(207) 786-3554
Entity
Organization
Contact information
Practice address
132 MAIN STREET, BOX 209, COOPERS MILLS, ME 04341
(207) 549-7471
(207) 549-3617
Mailing address
179 LISBON ST, 2ND FLOOR, LEWISTON, ME 04240-7248
(207) 786-3554
(207) 786-8507
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2004
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018204
BLUE CROSS PROVIDER #
ME
Enumeration date
12/13/2006
Last updated
08/22/2020
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