Provider Demographics
NPI:1053989806
Name:MONTVALE OPCO, LLC
Entity type:Organization
Organization Name:MONTVALE OPCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS LEAD
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-314-2619
Mailing Address - Street 1:295 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1805
Mailing Address - Country:US
Mailing Address - Phone:678-314-2619
Mailing Address - Fax:
Practice Address - Street 1:110 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1775
Practice Address - Country:US
Practice Address - Phone:201-201-8815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THRIVE SENIOR LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-16
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility