Healthcare Provider Details

I. General information

NPI: 1720608334
Provider Name (Legal Business Name): 2473 NORTH ROAD NE OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2473 NORTH RD NE
WARREN OH
44483-3054
US

IV. Provider business mailing address

2121 S GREEN RD STE 100
SOUTH EUCLID OH
44121-3318
US

V. Phone/Fax

Practice location:
  • Phone: 330-372-2251
  • Fax:
Mailing address:
  • Phone: 330-372-2251
  • 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: HAYLEY WILLIAMS
Title or Position: ATTORNEY
Credential:
Phone: 216-706-3936