Provider Demographics
NPI:1053140111
Name:OPCO IOWA CITY, IA, LLC
Entity type:Organization
Organization Name:OPCO IOWA CITY, 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:773-645-7246
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:736-459-2467
Mailing Address - Fax:
Practice Address - Street 1:3661 ROCHESTER AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9271
Practice Address - Country:US
Practice Address - Phone:319-351-7460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility