Healthcare Provider Details

I. General information

NPI: 1477313559
Provider Name (Legal Business Name): ELDERCREST OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W RUN RD
MUNHALL PA
15120-2869
US

IV. Provider business mailing address

1044 BROADWAY
WOODMERE NY
11598-1235
US

V. Phone/Fax

Practice location:
  • Phone: 412-462-8002
  • Fax:
Mailing address:
  • Phone: 516-869-3700
  • 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: ELIE POLLAK
Title or Position: MGR OF ELDERCREST OPCO MANAGER, LLC
Credential:
Phone: 718-440-7784