MEDICARE: EASTSIDE 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	:	1487423059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTSIDE OPCO LLC

Provider Business Mailing Address
First Line	:	62 PROSPECT ST
Second Line	:
City	:	WARSAW
State	:	NY
Zip	:	14569-1533
Country	:	US
Telephone Number	:	585-786-8151
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 PROSPECT ST
Second Line	:
City	:	WARSAW
State	:	NY
Zip	:	14569-1533
Country	:	US
Telephone Number	:	585-786-8151
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	AVROHOM J BROWN
Credential	:
Telephone Number	:	845-642-9186

Provider Enumeration Date	:	12/25/2023
Last Update Date	:	02/23/2025

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Directions to “EASTSIDE OPCO LLC ” Practice Location

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