Healthcare Provider Details

I. General information

NPI: 1780336255
Provider Name (Legal Business Name): MELBOURNE OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 SARNO RD
MELBOURNE FL
32934-7229
US

IV. Provider business mailing address

3033 SARNO RD
MELBOURNE FL
32934-7229
US

V. Phone/Fax

Practice location:
  • Phone: 321-255-9200
  • Fax: 321-255-9213
Mailing address:
  • Phone: 321-255-9200
  • Fax: 321-255-9213

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: MATHEW VARGHESE
Title or Position: MEMBER
Credential:
Phone: 917-817-3530