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NPI Code Detail

MEDICARE: EASTOVER SNF OPERATIONS LLC

MEDICARE: EASTOVER SNF OPERATIONS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1154141620
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTOVER SNF OPERATIONS LLC
Provider Business Mailing Address
First Line : 2616 E 5TH ST
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-4343
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2616 E 5TH ST
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-4343
Country : US
Telephone Number : 704-333-5165
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT OF PROCUREMENT
Name : JOSEPH LIEBERMAN
Credential :
Telephone Number : 646-275-4510
Provider Enumeration Date : 10/10/2024
Last Update Date : 10/10/2024

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Directions to “EASTOVER SNF OPERATIONS LLC ” Practice Location

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