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General NPI Number Information
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NPI Number | 1649855917
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Entity Type | Organization
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Legal Business Name | SOUTH HAVEN OPCO, LLC
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 120 BASELINE RD
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City | SOUTH HAVEN
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State | MI
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Zip | 49090-1037
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Country | US
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Telephone | 269-637-8411
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 NEW LA GRANGE RD STE 100
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City | LOUISVILLE
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State | KY
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Zip | 40222-4870
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Country | US
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Telephone | 502-429-8062
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Fax | 502-429-5980
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Authorized Official
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Title or Position | CHIEF LEGAL OFFICER
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Name | JONATHAN OHLSEN
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Credential | JD
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Telephone | 541-543-1215
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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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