Healthcare Provider Details

I. General information

NPI: 1114730439
Provider Name (Legal Business Name): 3000 WINDMILL ROAD OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 WINDMILL RD
SINKING SPRING PA
19608-1614
US

IV. Provider business mailing address

3000 WINDMILL RD
SINKING SPRING PA
19608-1614
US

V. Phone/Fax

Practice location:
  • Phone: 610-670-2100
  • Fax:
Mailing address:
  • Phone: 610-670-2100
  • 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: YISSOCHOR KOMIN
Title or Position: MANAGER OF SOLE MEMBER, OPA OPCO PA
Credential:
Phone: 908-510-8029