Healthcare Provider Details

I. General information

NPI: 1962174581
Provider Name (Legal Business Name): ROCHESTER 30 OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SILVER LAKE PL NW
ROCHESTER MN
55901-3257
US

IV. Provider business mailing address

1001 BRICKELL BAY DR STE 1504
MIAMI FL
33131-4938
US

V. Phone/Fax

Practice location:
  • Phone: 507-282-1550
  • Fax:
Mailing address:
  • Phone: 561-302-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW MARGOLIS
Title or Position: CORPORATE SECRETARY
Credential: JD, ESQ.
Phone: 561-302-2817