MEDICARE: BHCP HERITAGE VILLA 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	:	1568846194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHCP HERITAGE VILLA OPCO, LLC

Provider Business Mailing Address
First Line	:	2045 W GRAND AVE STE B-34572
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1576
Country	:	US
Telephone Number	:	773-645-9246
Fax Number	:

Provider Business Practice Location Address
First Line	:	1244 WOODLAND LOOP
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-5224
Country	:	US
Telephone Number	:	918-335-3222
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ISAAC DOLE
Credential	:
Telephone Number	:	773-645-9246

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	10/29/2024

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