Provider Demographics
NPI:1194702902
Name:MILLINGTON OPCO LP
Entity type:Organization
Organization Name:MILLINGTON OPCO LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-987-3707
Mailing Address - Street 1:5081 EASLEY ST
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-2105
Mailing Address - Country:US
Mailing Address - Phone:901-873-3290
Mailing Address - Fax:901-873-0531
Practice Address - Street 1:5081 EASLEY ST
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-2105
Practice Address - Country:US
Practice Address - Phone:901-873-3290
Practice Address - Fax:901-873-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000316314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN044-5425Medicaid
TN744-0556Medicaid
TN744-0556Medicaid