Healthcare Provider Details

I. General information

NPI: 1932868866
Provider Name (Legal Business Name): SB OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5377 MONCRIEF RD
JACKSONVILLE FL
32209-3159
US

IV. Provider business mailing address

211 BOULEVARD OF THE AMERICAS SUITE 209
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 904-768-1506
  • 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: ABRAHAM KRAUS
Title or Position: MEMBER
Credential:
Phone: 732-352-3943