Healthcare Provider Details

I. General information

NPI: 1225561376
Provider Name (Legal Business Name): CW OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6831 CHAPEL RD
MADISON OH
44057-2255
US

IV. Provider business mailing address

300 GLEED AVE
EAST AURORA NY
14052-2983
US

V. Phone/Fax

Practice location:
  • Phone: 440-428-5103
  • 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: ALEXANDER SHERMAN
Title or Position: MANAGER
Credential:
Phone: 718-207-1714