Provider Demographics
NPI:1174411961
Name:1424 FALLBROOK DR OPCO LLC
Entity type:Organization
Organization Name:1424 FALLBROOK DR OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOCHUM
Authorized Official - Middle Name:
Authorized Official - Last Name:FREUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-719-5098
Mailing Address - Street 1:1424 FALLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77038-1846
Mailing Address - Country:US
Mailing Address - Phone:346-754-5070
Mailing Address - Fax:281-741-0355
Practice Address - Street 1:1424 FALLBROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77038-1846
Practice Address - Country:US
Practice Address - Phone:346-754-5070
Practice Address - Fax:281-741-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility