MEDICARE: BECKETT HOUSE 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	:	1316414519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BECKETT HOUSE OPCO, LLC

Provider Business Mailing Address
First Line	:	5990 VENTURE DR STE A
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-2273
Country	:	US
Telephone Number	:	216-772-3192
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280 FRIENDSHIP DR
Second Line	:
City	:	NEW CONCORD
State	:	OH
Zip	:	43762-1024
Country	:	US
Telephone Number	:	740-872-0809
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	JASON DIPASQUA
Credential	:
Telephone Number	:	330-652-2053

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	10/23/2024

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