Healthcare Provider Details

I. General information

NPI: 1578960795
Provider Name (Legal Business Name): KALAMAZOO OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S 11TH ST
KALAMAZOO MI
49009-1775
US

IV. Provider business mailing address

7400 NEW LA GRANGE RD SUITE 100
LOUISVILLE KY
40222-4870
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-2020
  • Fax: 269-375-7990
Mailing address:
  • Phone: 502-429-8062
  • Fax: 502-429-0650

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: MR. STACEY PAUL ROGERS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 502-429-8062