Healthcare Provider Details

I. General information

NPI: 1467319103
Provider Name (Legal Business Name): WAKEFIELD OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BATHOL ST
WAKEFIELD MA
01880-3655
US

IV. Provider business mailing address

1 BATHOL ST
WAKEFIELD MA
01880-3655
US

V. Phone/Fax

Practice location:
  • Phone: 781-245-7600
  • 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: ELIYAHU MIRLIS
Title or Position: MANAGER
Credential:
Phone: 973-796-6175