MEDICARE: 3000 N DANVILLE ST 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	:	1508744012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3000 N DANVILLE ST OPCO LLC

Provider Business Mailing Address
First Line	:	3000 N DANVILLE ST
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-3490
Country	:	US
Telephone Number	:	732-719-5098
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 N DANVILLE ST
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-3490
Country	:	US
Telephone Number	:	732-719-5098
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NOCHUM FREUND
Credential	:
Telephone Number	:	732-719-5098

Provider Enumeration Date	:	08/22/2025
Last Update Date	:	08/22/2025

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