Healthcare Provider Details

I. General information

NPI: 1144085614
Provider Name (Legal Business Name): OPS LIVING SB MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 S IRONWOOD DR
SOUTH BEND IN
46614-2200
US

IV. Provider business mailing address

5904 E STATE BLVD
FORT WAYNE IN
46815-7637
US

V. Phone/Fax

Practice location:
  • Phone: 574-291-2222
  • Fax: 260-498-2059
Mailing address:
  • Phone: 260-740-3220
  • Fax: 260-498-2059

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: SHERRI BERGHOFF
Title or Position: CEO
Credential:
Phone: 260-740-3220