MEDICARE: ELKTON 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100395	OTHER	KY	LICENSE

General Provider Information

NPI Number	:	1083592869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELKTON OPCO LLC

Provider Business Mailing Address
First Line	:	506 ALLENSVILLE ST
Second Line	:
City	:	ELKTON
State	:	KY
Zip	:	42220-8834
Country	:	US
Telephone Number	:	270-265-5321
Fax Number	:	270-265-3526

Provider Business Practice Location Address
First Line	:	506 ALLENSVILLE ST
Second Line	:
City	:	ELKTON
State	:	KY
Zip	:	42220-8834
Country	:	US
Telephone Number	:	270-265-5321
Fax Number	:	270-265-3526

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MOSHE KELMAN
Credential	:
Telephone Number	:	270-265-5321

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	08/21/2025

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Directions to “ELKTON OPCO LLC ” Practice Location

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