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NPI Code Detail

MEDICARE: OPCO POLK CITY, IA, LLC

MEDICARE: OPCO POLK CITY, IA, 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 : 1841822731
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPCO POLK CITY, IA, LLC
Provider Business Mailing Address
First Line : 2045 W GRAND AVE STE B34572
Second Line :
City : CHICAGO
State : IL
Zip : 60612-1576
Country : US
Telephone Number : 312-724-8950
Fax Number :
Provider Business Practice Location Address
First Line : 1002 W WASHINGTON AVE
Second Line :
City : POLK CITY
State : IA
Zip : 50226-2132
Country : US
Telephone Number : 515-984-6511
Fax Number :
Authorized Official
Title or Position : PRESIDENT OF MANAGER
Name : ISAAC DOLE
Credential :
Telephone Number : 773-645-9246
Provider Enumeration Date : 02/07/2020
Last Update Date : 10/29/2024

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Directions to “OPCO POLK CITY, IA, LLC ” Practice Location

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