Healthcare Provider Details

I. General information

NPI: 1811624935
Provider Name (Legal Business Name): WASHINGTON OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 USERY RD
CHIPLEY FL
32428-9303
US

IV. Provider business mailing address

2901 STIRLING RD STE 200
FORT LAUDERDALE FL
33312-6529
US

V. Phone/Fax

Practice location:
  • Phone: 954-300-3878
  • Fax:
Mailing address:
  • Phone: 954-300-3878
  • 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: JACOB BENGIO
Title or Position: CFO
Credential:
Phone: 954-300-3878