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NPI Code Detail

MEDICARE: WALNUT CREEK SNF OPCO LLC

MEDICARE: WALNUT CREEK SNF 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1164279022
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALNUT CREEK SNF OPCO LLC
Provider Business Mailing Address
First Line : 5910 LANDERBROOK DR STE 150
Second Line :
City : MAYFIELD HEIGHTS
State : OH
Zip : 44124-6506
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5070 LAMME RD
Second Line :
City : MORAINE
State : OH
Zip : 45439-3266
Country : US
Telephone Number : 330-620-7828
Fax Number :
Authorized Official
Title or Position : VP OF OPERATIONS
Name : JEFFREY DEGYANSKY
Credential :
Telephone Number : 330-620-7828
Provider Enumeration Date : 04/30/2024
Last Update Date : 12/04/2025

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Directions to “WALNUT CREEK SNF OPCO LLC ” Practice Location

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