Healthcare Provider Details

I. General information

NPI: 1770477036
Provider Name (Legal Business Name): OPCO WELLMAN, IA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 13TH ST
WELLMAN IA
52356-9232
US

IV. Provider business mailing address

2045 W GRAND AVE STE B-34572
CHICAGO IL
60612-1576
US

V. Phone/Fax

Practice location:
  • Phone: 319-646-2911
  • Fax:
Mailing address:
  • Phone: 872-282-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: ISAAC DOLE
Title or Position: MANAGING MEMBER
Credential:
Phone: 872-282-8001