Healthcare Provider Details

I. General information

NPI: 1114480233
Provider Name (Legal Business Name): EASTOVER OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 E 5TH ST
CHARLOTTE NC
28204-4343
US

IV. Provider business mailing address

2616 E 5TH ST
CHARLOTTE NC
28204-4343
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-5165
  • Fax:
Mailing address:
  • Phone: 704-333-5165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NAFTALI ZANZIPER
Title or Position: PRESIDENT
Credential:
Phone: 917-297-7658