Provider Demographics
NPI:1407395999
Name:MARSHFIELD OPERATIONS MANAGEMENT LLC
Entity Type:Organization
Organization Name:MARSHFIELD OPERATIONS MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-836-0436
Mailing Address - Street 1:33 WEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1451
Mailing Address - Country:US
Mailing Address - Phone:917-836-0436
Mailing Address - Fax:
Practice Address - Street 1:800 S WHITE OAK RD
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2231
Practice Address - Country:US
Practice Address - Phone:417-859-3701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMO SNF MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
265577Medicare Oscar/Certification