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General NPI Number Information
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NPI Number | 1174290100
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Entity Type | Organization
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Legal Business Name | GA OPCO LLC
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 411 PINE ST
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City | SYLVANIA
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State | GA
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Zip | 30467-2035
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Country | US
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Telephone | 912-564-2015
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Fax | 912-564-9218
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Provider Business Mailing Address
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Address Line | 411 PINE ST
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City | SYLVANIA
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State | GA
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Zip | 30467-2035
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Country | US
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Telephone | 912-564-2015
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Fax | 912-564-9218
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Authorized Official
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Title or Position | AUTHORIZED SIGNATORY
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Name | JOSEF NEUMAN
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Credential |
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Telephone | 912-564-2015
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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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