Healthcare Provider Details

I. General information

NPI: 1932030087
Provider Name (Legal Business Name): 3410 BEAVER AVENUE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 BEAVER AVE
DES MOINES IA
50310-3271
US

IV. Provider business mailing address

4500 DORR ST
TOLEDO OH
43615-4040
US

V. Phone/Fax

Practice location:
  • Phone: 515-777-5105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARON MAKOWSKY
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 419-247-2800