MEDICARE: MICHIGAN BS 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	:	1356285282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN BS OPCO LLC

Provider Business Mailing Address
First Line	:	2360 LAKEWOOD RD STE 2
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-1929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21630 HESSEL AVE # 1230
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-1230
Country	:	US
Telephone Number	:	313-534-8400
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MENACHEM P KOFMAN
Credential	:
Telephone Number	:	732-908-1218

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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