Healthcare Provider Details

I. General information

NPI: 1538023080
Provider Name (Legal Business Name): GLENDALE WI OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W SILVER SPRING DR
GLENDALE WI
53209-4415
US

IV. Provider business mailing address

300 BOULEVARD OF THE AMERICAS STE 101
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 414-228-8120
  • Fax:
Mailing address:
  • Phone:
  • 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: AHARON FRANCO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 646-823-6464