MEDICARE: LP OPCO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1033642186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LP OPCO, LLC

Provider Business Mailing Address
First Line	:	300 GLEED AVE
Second Line	:
City	:	EAST AURORA
State	:	NY
Zip	:	14052-2983
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 PARRISH RD
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-1178
Country	:	US
Telephone Number	:	440-593-6266
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ALEXANDER SHERMAN
Credential	:
Telephone Number	:	718-207-1714

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	04/05/2017

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Directions to “LP OPCO, LLC ” Practice Location

Language	Start Address	Practice Location

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