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NPI Code Detail

MEDICARE: BENTON HARBOR OPCO II LLC

MEDICARE: BENTON HARBOR OPCO II 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1144743907
Entity Type Code : Organization
Provider Name (Legal Business Name) : BENTON HARBOR OPCO II LLC
Provider Business Mailing Address
First Line : 1385 E EMPIRE AVE
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-2037
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1385 E EMPIRE AVE
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-2037
Country : US
Telephone Number : 269-925-0033
Fax Number :
Authorized Official
Title or Position : AUTHORIZED REP
Name : LEONID BERKOVICH
Credential :
Telephone Number : 773-704-6341
Provider Enumeration Date : 07/24/2017
Last Update Date : 05/08/2018

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Directions to “BENTON HARBOR OPCO II LLC ” Practice Location

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