Healthcare Provider Details

I. General information

NPI: 1174290100
Provider Name (Legal Business Name): GA OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 PINE ST
SYLVANIA GA
30467-2035
US

IV. Provider business mailing address

411 PINE ST
SYLVANIA GA
30467-2035
US

V. Phone/Fax

Practice location:
  • Phone: 912-564-2015
  • Fax: 912-564-9218
Mailing address:
  • Phone: 912-564-2015
  • Fax: 912-564-9218

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: JOSEF NEUMAN
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 912-564-2015