=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730808064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MI SNF OPCO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2022
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 S COURTENAY PKWY
-----------------------------------------------------
City | MERRITT ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32952-3804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-452-1233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5151 CHURCH ST
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-1123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-933-9200
-----------------------------------------------------
Fax | 847-933-9765
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | AVRUM WEINFELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-933-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------