=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396682951
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AIKEN OPCO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2026
-----------------------------------------------------
Last Update Date | 05/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3525 AUGUSTUS RD
-----------------------------------------------------
City | AIKEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29801-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-642-8376
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3525 AUGUSTUS RD
-----------------------------------------------------
City | AIKEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29801-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-642-8376
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED SIGNATORY
-----------------------------------------------------
Name | GABRIEL SEBBAG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-373-0473
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------