Healthcare Provider Details

I. General information

NPI: 1598419467
Provider Name (Legal Business Name): 324 KING GEORGE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 KING GEORGE AVE SW
ROANOKE VA
24016-5213
US

IV. Provider business mailing address

117 VAN BUREN AVE
LAKEWOOD NJ
08701-2361
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-8139
  • Fax:
Mailing address:
  • Phone: 540-632-0235
  • 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: MEYER WEISZ
Title or Position: COO
Credential:
Phone: 540-632-0235