Provider Demographics
NPI:1386473239
Name:OPCO DAYTON, IA, LLC
Entity type:Organization
Organization Name:OPCO DAYTON, IA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF THE LLC
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-645-9246
Mailing Address - Street 1:2045 W GRAND AVE STE B-34572
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1576
Mailing Address - Country:US
Mailing Address - Phone:773-645-9246
Mailing Address - Fax:
Practice Address - Street 1:508 2ND ST NE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:IA
Practice Address - Zip Code:50530-7530
Practice Address - Country:US
Practice Address - Phone:515-547-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility