Healthcare Provider Details

I. General information

NPI: 1457836504
Provider Name (Legal Business Name): SD OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17475 S DIXIE HWY
MIAMI FL
33157-5434
US

IV. Provider business mailing address

17475 S DIXIE HWY
MIAMI FL
33157-5434
US

V. Phone/Fax

Practice location:
  • Phone: 305-255-1045
  • Fax: 786-227-6624
Mailing address:
  • Phone: 305-255-1045
  • Fax: 786-227-6624

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: GEORGE FERNANDEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-255-1045