Provider Demographics
NPI:1245700467
Name:2215 NORTHPORT OPCO LLC
Entity type:Organization
Organization Name:2215 NORTHPORT OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHALOM
Authorized Official - Middle Name:
Authorized Official - Last Name:LERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-564-6560
Mailing Address - Street 1:2215 32ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-5230
Mailing Address - Country:US
Mailing Address - Phone:205-339-5400
Mailing Address - Fax:205-339-3455
Practice Address - Street 1:2215 32ND ST
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-5230
Practice Address - Country:US
Practice Address - Phone:205-339-5400
Practice Address - Fax:205-339-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility