Provider Demographics
NPI:1215404330
Name:BRYAN OPCO LLC
Entity type:Organization
Organization Name:BRYAN OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:DEVIN
Authorized Official - Last Name:GUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-800-4954
Mailing Address - Street 1:2431 S ACADIAN THRUWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2300
Mailing Address - Country:US
Mailing Address - Phone:225-800-4954
Mailing Address - Fax:225-308-2278
Practice Address - Street 1:2817 KENT ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5214
Practice Address - Country:US
Practice Address - Phone:979-776-7521
Practice Address - Fax:979-774-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility