Healthcare Provider Details

I. General information

NPI: 1639749781
Provider Name (Legal Business Name): AUGUSTA KY OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5269 ASBURY RD
AUGUSTA KY
41002-9215
US

IV. Provider business mailing address

5269 ASBURY RD
AUGUSTA KY
41002-9215
US

V. Phone/Fax

Practice location:
  • Phone: 646-649-1131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ISAAC MOSKOWITZ
Title or Position: MANAGER
Credential:
Phone: 646-649-1131