SJ3 Op Divers LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SJ3 OP DIVERS LLC

Practice address

3002 N 18TH St
Saint Joseph, MO 64505-1872

Phone

(516) 364-4200

NPI assigned

Sep 14, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel Goldner

Title

Authorized Person

Phone

(516) 727-1634

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663113600000",
    "number": "1063134294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 CHESTNUT ST STE 102",
            "city": "CEDARHURST",
            "state": "NY",
            "postal_code": "115162223",
            "telephone_number": "516-727-1634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3002 N 18TH ST",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645051872",
            "telephone_number": "516-364-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SJ3 OP DIVERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-14",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A",
        "authorized_official_last_name": "GOLDNER",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "AUTHORIZED PERSON",
        "authorized_official_telephone_number": "516-727-1634"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney Danielle Simmons, FNP
• Haley Simpson, CRNA
• Justin Aaron Simpson, D.O.
• Zachary Thomas Siress, DO
• SJ3 Op Chateau LLC
• SJ3 Op Riverside LLC
• Holly Skocny, FNP
• Evan Richard Slanczka, D.O.
• Smart Plate Nutrition LLC
• Allison Mae Smith, APRN

• Skilled Nursing Facility in Saint Joseph, MO
• Providers in Saint Joseph, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.