Healthcare Provider Details

I. General information

NPI: 1760423065
Provider Name (Legal Business Name): OP HAZELTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 E BROAD ST
HAZLETON PA
18201-5691
US

IV. Provider business mailing address

800 CONCOURSE PKWY S SUITE 200
MAITLAND FL
32751-6148
US

V. Phone/Fax

Practice location:
  • Phone: 570-453-5100
  • Fax: 570-453-5138
Mailing address:
  • Phone: 407-571-1550
  • Fax: 407-571-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number195202
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1012273990001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: JOSEPH CONTE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 407-571-1550