Healthcare Provider Details

I. General information

NPI: 1528702461
Provider Name (Legal Business Name): SHIPPENSBURG OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WALNUT BOTTOM RD
SHIPPENSBURG PA
17257-8131
US

IV. Provider business mailing address

121 WALNUT BOTTOM RD
SHIPPENSBURG PA
17257-8131
US

V. Phone/Fax

Practice location:
  • Phone: 717-530-8300
  • Fax:
Mailing address:
  • Phone: 717-530-8300
  • 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: MR. ROBERT KOLMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 917-295-1882