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General NPI Number Information
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NPI Number | 1366255655
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Entity Type | Organization
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Legal Business Name | 2029 WESTGATE DRIVE OPCO LLC
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 2029 WESTGATE DR
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City | BETHLEHEM
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State | PA
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Zip | 18017-7412
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Country | US
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Telephone | 610-861-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 2029 WESTGATE DR
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City | BETHLEHEM
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State | PA
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Zip | 18017-7412
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Country | US
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Telephone | 610-861-0100
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Fax |
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Authorized Official
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Title or Position | MANAGER OF SOLE MEMBER, OPA OPCO PA
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Name | YISSOCHOR KOMIN
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Credential |
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Telephone | 908-510-8029
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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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