Provider Demographics
NPI:1477043222
Name:SRZ OP ROLLA LLC
Entity Type:Organization
Organization Name:SRZ OP ROLLA LLC
Other - Org Name:ROLLA HEALTH & REHABILITATION SUITES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED PERSON/OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-677-0448
Mailing Address - Street 1:22 HERRICK DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1528
Mailing Address - Country:US
Mailing Address - Phone:929-928-0307
Mailing Address - Fax:
Practice Address - Street 1:1200 MCCUTCHEN RD
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2615
Practice Address - Country:US
Practice Address - Phone:573-364-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SRZ OP HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility