Healthcare Provider Details

I. General information

NPI: 1316772601
Provider Name (Legal Business Name): DOVER SNF OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MIDDLE ROAD
DOVER NH
03820-4146
US

IV. Provider business mailing address

60 MIDDLE ROAD
DOVER NH
03820-4146
US

V. Phone/Fax

Practice location:
  • Phone: 603-714-4935
  • Fax:
Mailing address:
  • Phone: 603-714-4935
  • 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: SEAN STEVENSON
Title or Position: PRINCIPAL
Credential:
Phone: 603-714-4935