Provider Demographics
NPI:1124997465
Name:GRAND ISLAND OPCO LLC
Entity type:Organization
Organization Name:GRAND ISLAND OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SMILOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-543-4391
Mailing Address - Street 1:800 STOEGER DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4404
Mailing Address - Country:US
Mailing Address - Phone:308-382-5440
Mailing Address - Fax:
Practice Address - Street 1:800 STOEGER DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4404
Practice Address - Country:US
Practice Address - Phone:308-382-5440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility