Provider Demographics
NPI:1598359085
Name:SHERIDAN OPCO LLC
Entity Type:Organization
Organization Name:SHERIDAN OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:ORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-838-0053
Mailing Address - Street 1:950 S CHERRY ST STE 716
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2665
Mailing Address - Country:US
Mailing Address - Phone:347-838-0053
Mailing Address - Fax:
Practice Address - Street 1:1851 BIG HORN AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5913
Practice Address - Country:US
Practice Address - Phone:307-674-4416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility