Provider Demographics
NPI:1306615018
Name:GATESVILLE NC OPCO LLC
Entity type:Organization
Organization Name:GATESVILLE NC OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ITAMAR
Authorized Official - Middle Name:BINYOMIN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-357-2124
Mailing Address - Street 1:38 CARTERS RD
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27938-9302
Mailing Address - Country:US
Mailing Address - Phone:252-357-2124
Mailing Address - Fax:
Practice Address - Street 1:38 CARTERS RD
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27938-9302
Practice Address - Country:US
Practice Address - Phone:252-357-2124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility