115 South Providence Road Opco LLC
NPI #1083427306 in Wallingford, Pennsylvania
Provider Information
- NPI Number
- 1083427306
- Entity Type
- Organization
- Organization Name
- 115 South Providence Road Opco LLC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- OPA OPCO PARENT LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Jan 30, 2025
- Last Updated
- Jan 30, 2025
Practice Location
- Address
- 115 S PROVIDENCE RD
- City
- Wallingford
- State
- Pennsylvania
- ZIP Code
- 19086-6333
- Phone
- (610) 565-3232
Authorized Official
- Name
- YISSOCHOR KOMIN
- Title
- MANAGER OF SOLE MEMBER, OPA OPCO PA
- Phone
- (908) 510-8029
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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