Healthcare Provider Details

I. General information

NPI: 1033044755
Provider Name (Legal Business Name): CLOVERDALE SNF OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W CLOVERDALE RD
SCOTTSBORO AL
35768-4264
US

IV. Provider business mailing address

365 ROUTE 59 STE 211
AIRMONT NY
10952-3473
US

V. Phone/Fax

Practice location:
  • Phone: 256-259-1505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: YEHUDA HERZ
Title or Position: MANAGING PARTNER
Credential:
Phone: 551-795-7270