NPI 1417852245 · live from the CMS NPI Registry
Agawam South Operating LLC
Skilled Nursing Facility in Agawam, MA. National Provider Identifier 1417852245, active.
NPI record
| NPI | 1417852245 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Skilled Nursing Facility 314000000X |
| Practice location | 65 Cooper St, Agawam, MA 01001 |
| Practice phone | 413-786-8000 |
| Mailing address | 1869 Craig Park Ct, Saint Louis, MO 63146 |
| Enumerated | October 12, 2026 |
| Last updated | October 12, 2026 |
| Authorized official | Nicholas Destefane, Ceo |
| Other names | Agawam South Rehab And Nursing |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Skilled Nursing Facility primary | 314000000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.