Provider Demographics
NPI:1932997590
Name:LIVONIA OPCO LLC
Entity type:Organization
Organization Name:LIVONIA OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:RANEL
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-846-3521
Mailing Address - Street 1:29270 MORLOCK ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2044
Mailing Address - Country:US
Mailing Address - Phone:248-476-0555
Mailing Address - Fax:248-477-5391
Practice Address - Street 1:29270 MORLOCK ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2044
Practice Address - Country:US
Practice Address - Phone:248-475-0555
Practice Address - Fax:248-477-5391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility