Healthcare Provider Details

I. General information

NPI: 1124997465
Provider Name (Legal Business Name): GRAND ISLAND OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 STOEGER DR
GRAND ISLAND NE
68803-4404
US

IV. Provider business mailing address

800 STOEGER DR
GRAND ISLAND NE
68803-4404
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-5440
  • Fax:
Mailing address:
  • Phone: 308-382-5440
  • 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: ABRAHAM SMILOW
Title or Position: AUTHORIZED SIGNER
Credential:
Phone: 917-543-4391