Healthcare Provider Details

I. General information

NPI: 1922824523
Provider Name (Legal Business Name): LAPEER MI OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 S MAIN ST
LAPEER MI
48446-2426
US

IV. Provider business mailing address

239 S MAIN ST
LAPEER MI
48446-2426
US

V. Phone/Fax

Practice location:
  • Phone: 810-664-6611
  • 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: JACOB TAUL
Title or Position: SOLE MEMBER
Credential:
Phone: 917-703-3274