Healthcare Provider Details

I. General information

NPI: 1134987878
Provider Name (Legal Business Name): 10200 LA PLATA OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 LA PLATA ROAD
LAPLATA MD
20646
US

IV. Provider business mailing address

1135 E VETERANS HWY BLDG STE 1
JACKSON NJ
08527-5090
US

V. Phone/Fax

Practice location:
  • Phone: 301-934-1900
  • 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: MANNY STERN
Title or Position: MANAGER
Credential:
Phone: 301-934-1900