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NPI Code Detail

MEDICARE: MAYBROOK-C OVERLOOK OPCO, LLC

MEDICARE: MAYBROOK-C OVERLOOK 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1528429107
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAYBROOK-C OVERLOOK OPCO, LLC
Provider Business Mailing Address
First Line : 520 NEW CASTLE STREET
Second Line :
City : NEW WILMINGTON
State : PA
Zip : 16142
Country : US
Telephone Number : 724-946-3511
Fax Number :
Provider Business Practice Location Address
First Line : 520 S NEW CASTLE ST
Second Line :
City : NEW WILMINGTON
State : PA
Zip : 16142-1446
Country : US
Telephone Number : 724-946-3511
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. LLOYD BERKEY
Credential :
Telephone Number : 724-946-3511
Provider Enumeration Date : 03/10/2016
Last Update Date : 05/10/2019

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Directions to “MAYBROOK-C OVERLOOK OPCO, LLC ” Practice Location

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