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General NPI Number Information
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NPI Number | 1487423059
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Entity Type | Organization
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Legal Business Name | EASTSIDE OPCO LLC
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Dates
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Enumeration Date | 12/25/2023
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Last Update Date | 02/23/2025
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Provider Practice Location Address
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Address Line | 62 PROSPECT ST
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City | WARSAW
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State | NY
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Zip | 14569-1533
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Country | US
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Telephone | 585-786-8151
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Fax |
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Provider Business Mailing Address
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Address Line | 62 PROSPECT ST
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City | WARSAW
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State | NY
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Zip | 14569-1533
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Country | US
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Telephone | 585-786-8151
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | AVROHOM J BROWN
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Credential |
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Telephone | 845-642-9186
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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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