MEDICARE: SJCC OPCO-SNF, 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	:	1376339499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SJCC OPCO-SNF, LLC

Provider Business Mailing Address
First Line	:	811 S MAIN ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-3156
Country	:	US
Telephone Number	:	330-838-0058
Fax Number	:

Provider Business Practice Location Address
First Line	:	2308 RENO DR
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-9083
Country	:	US
Telephone Number	:	330-875-5562
Fax Number	:	330-875-8947

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDY HARPSTER
Credential	:
Telephone Number	:	330-838-0058

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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