Healthcare Provider Details

I. General information

NPI: 1043921091
Provider Name (Legal Business Name): 10425 OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10425 CHESTNUT DR
KANSAS CITY MO
64137-3201
US

IV. Provider business mailing address

4525 WILSHIRE BLVD STE 210
LOS ANGELES CA
90010-3846
US

V. Phone/Fax

Practice location:
  • Phone: 816-763-4444
  • 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: DAVID GARETZ
Title or Position: CFO
Credential:
Phone: 213-395-1848