Provider Demographics
NPI:1215536768
Name:OPDYNASTY LLC
Entity Type:Organization
Organization Name:OPDYNASTY LLC
Other - Org Name:OPDYNASTY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EKLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-300-2442
Mailing Address - Street 1:4000 LEGATO RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2893
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 LEGATO RD STE 1100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2893
Practice Address - Country:US
Practice Address - Phone:703-300-2442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-25
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health