Healthcare Provider Details

I. General information

NPI: 1245796341
Provider Name (Legal Business Name): AMELIA OPERATING REALTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8830 VIRGINIA ST
AMELIA COURT HOUSE VA
23002-4826
US

IV. Provider business mailing address

4711 GOLF RD STE 200
SKOKIE IL
60076-1236
US

V. Phone/Fax

Practice location:
  • Phone: 804-561-5611
  • Fax:
Mailing address:
  • Phone: 847-933-9280
  • 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: ABRAHAM GUTNICKI
Title or Position: MANAGER
Credential:
Phone: 847-933-9280