Provider Demographics
NPI:1154299386
Name:TP KCB HARBOUR VILLAGE OPCO, LLC
Entity type:Organization
Organization Name:TP KCB HARBOUR VILLAGE OPCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-921-0531
Mailing Address - Street 1:2265 E MURRAY HOLLADAY RD
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5379
Mailing Address - Country:US
Mailing Address - Phone:917-921-0531
Mailing Address - Fax:
Practice Address - Street 1:5900 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1459
Practice Address - Country:US
Practice Address - Phone:414-421-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)