Provider Demographics
NPI:1518763317
Name:1638 VZ CR 1803 OPCO LLC
Entity type:Organization
Organization Name:1638 VZ CR 1803 OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-719-5098
Mailing Address - Street 1:1638 VZ COUNTY ROAD 1803
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-3494
Mailing Address - Country:US
Mailing Address - Phone:903-962-7595
Mailing Address - Fax:903-962-7202
Practice Address - Street 1:1638 VZ COUNTY ROAD 1803
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-3494
Practice Address - Country:US
Practice Address - Phone:903-962-7595
Practice Address - Fax:903-962-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility