MEDICARE: MINNEAPOLIS KS 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	:	1972098853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINNEAPOLIS KS OPCO LLC

Provider Business Mailing Address
First Line	:	2071 FLATBUSH AVE STE 12
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4340
Country	:	US
Telephone Number	:	212-390-1054
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 N ROTHSAY AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	KS
Zip	:	67467-1637
Country	:	US
Telephone Number	:	212-390-1054
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ISAAC MOSKOWITZ
Credential	:
Telephone Number	:	212-390-1054

Provider Enumeration Date	:	06/24/2018
Last Update Date	:	06/24/2018

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