MEDICARE: PHOENIX AZ 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	:	1689316135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX AZ OPCO LLC

Provider Business Mailing Address
First Line	:	980 SYLVAN AVE
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-3301
Country	:	US
Telephone Number	:	201-928-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	8825 S 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7626
Country	:	US
Telephone Number	:	602-243-6121
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	BATYA GORELICK
Credential	:
Telephone Number	:	201-928-7800

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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Directions to “PHOENIX AZ OPCO LLC ” Practice Location

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