Provider Demographics
NPI:1841736725
Name:KALAMAZOO OPCO II, LLC
Entity Type:Organization
Organization Name:KALAMAZOO OPCO II, LLC
Other - Org Name:HALLMARK LIVING KALAMAZOO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SIMCHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANDELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-344-8712
Mailing Address - Street 1:3625 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-5427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3625 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-5427
Practice Address - Country:US
Practice Address - Phone:269-375-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
235114Medicare Oscar/Certification