Provider Demographics
NPI:1801532122
Name:520 KERR AVENUE OPCO LLC
Entity type:Organization
Organization Name:520 KERR AVENUE OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YECHIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-744-4611
Mailing Address - Street 1:14C 53RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2644
Mailing Address - Country:US
Mailing Address - Phone:877-567-0402
Mailing Address - Fax:
Practice Address - Street 1:520 KERR AVE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1343
Practice Address - Country:US
Practice Address - Phone:410-479-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No385H00000XRespite Care FacilityRespite Care