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General NPI Number Information
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NPI Number | 1114891587
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Entity Type | Organization
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Legal Business Name | CLARKSTON OPCO LLC
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Dates
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Enumeration Date | 09/30/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 4800 CLINTONVILLE RD
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City | CLARKSTON
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State | MI
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Zip | 48346-4297
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Country | US
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Telephone | 248-674-0903
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Fax | 248-674-3431
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Provider Business Mailing Address
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Address Line | 3701 W LUNT AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-2615
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Country | US
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Telephone | 224-470-2044
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Fax | 224-470-2952
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Authorized Official
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Title or Position | CFO
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Name | MARCELLA GRAF
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Credential |
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Telephone | 224-470-2044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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