Healthcare Provider Details

I. General information

NPI: 1376339499
Provider Name (Legal Business Name): SJCC OPCO-SNF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 RENO DR
LOUISVILLE OH
44641-9083
US

IV. Provider business mailing address

811 S MAIN ST
NORTH CANTON OH
44720-3156
US

V. Phone/Fax

Practice location:
  • Phone: 330-875-5562
  • Fax: 330-875-8947
Mailing address:
  • Phone: 330-838-0058
  • 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: ANDY HARPSTER
Title or Position: PRESIDENT
Credential:
Phone: 330-838-0058