Provider Demographics
NPI:1821491150
Name:S-H OPCO EASTOVER, LLC
Entity Type:Organization
Organization Name:S-H OPCO EASTOVER, LLC
Other - Org Name:EMERITUS AT EASTOVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:OHLENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5000
Mailing Address - Street 1:1920 MAIN ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7209
Mailing Address - Country:US
Mailing Address - Phone:949-407-0700
Mailing Address - Fax:
Practice Address - Street 1:3610 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1318
Practice Address - Country:US
Practice Address - Phone:704-366-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility