=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952295289
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPCO OAKLAND, IA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2025
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 737 N HIGHWAY ST
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51560-4075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-482-6403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2045 W GRAND AVE STE B-34572
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60612-1576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-645-9246
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | ISAAC DOLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-645-9246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------