Healthcare Provider Details

I. General information

NPI: 1366327884
Provider Name (Legal Business Name): NBH1 MTOPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11988 MARK TWAIN LN
BRIDGETON MO
63044-2825
US

IV. Provider business mailing address

525 ROUTE 70 STE 3B
BRICK NJ
08723-4022
US

V. Phone/Fax

Practice location:
  • Phone: 314-291-8240
  • Fax:
Mailing address:
  • Phone: 305-490-6963
  • 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: AVRAHAM LAPCIUC
Title or Position: PARTNER
Credential: MBA
Phone: 305-490-6963