Organization
COUNTRY ESTATES NURSING, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARILYN WEAVER (ASSISTANT SECRETARY)
(502) 596-7563
Entity
Organization
Contact information
Practice address
1200 SUFFIELD ST, AGAWAM, MA 01001-2933
(413) 789-2200
(413) 789-2269
Mailing address
680 S 4TH ST # KH-2, LOUISVILLE, KY 40202-2407
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0967
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000024954
BMC HEALTH NET
MA
01
—
0029577
MARTINS POINT
MA
05
—
0927929
—
MA
01
—
1190138
UNITED HEALTH CARE
MA
01
—
2222564201
BLUE CROSS BLUE SHIELD
MA
01
—
225642
CCS
MA
01
—
71-01051
CIGNA
MA
01
—
982257
MULTIPLAN
MA
Enumeration date
08/24/2006
Last updated
01/17/2018
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