Healthcare Provider Details

I. General information

NPI: 1700657822
Provider Name (Legal Business Name): ILIFF OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 ILIFF DR
DUNN LORING VA
22027-1235
US

IV. Provider business mailing address

8000 ILIFF DR
DUNN LORING VA
22027-1235
US

V. Phone/Fax

Practice location:
  • Phone: 703-560-1000
  • Fax: 703-643-4780
Mailing address:
  • Phone: 703-560-1000
  • Fax: 703-643-4780

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: ITAMAR BINYOMIN COHEN
Title or Position: CEO
Credential:
Phone: 252-331-2126