Healthcare Provider Details

I. General information

NPI: 1346026119
Provider Name (Legal Business Name): MIAMI OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 NE 191ST ST
MIAMI FL
33179-3711
US

IV. Provider business mailing address

144 SHADY LANE DR
LAKEWOOD NJ
08701-2351
US

V. Phone/Fax

Practice location:
  • Phone: 718-916-1443
  • Fax:
Mailing address:
  • Phone: 732-364-2444
  • 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: JOE NEUMAN
Title or Position: AUTHORIZED MEMBER
Credential:
Phone: 718-916-1443