900 Tuck Street Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

900 TUCK STREET OPCO LLC

Practice address

900 Tuck St
Lebanon, PA 17042-7446

Phone

(717) 273-8595

NPI assigned

Jan 30, 2025

Organization subpart

Yes

Parent organization

OPA OPCO PARENT LLCAs reported in NPPES

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

Authorized official

Name

Yissochor Komin

Title

Manager of Sole Member, Opa Opco PA

Phone

(908) 510-8029

Specialties & licenses 1

Addresses

Other names 1

• Altira at Lebanon Doing business as

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

{
    "created_epoch": "1738195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738195200000",
    "number": "1164235479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 TUCK ST",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427446",
            "telephone_number": "717-273-8595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 TUCK ST",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427446",
            "telephone_number": "717-273-8595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "900 TUCK STREET OPCO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPA OPCO PARENT LLC",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A",
        "authorized_official_last_name": "KOMIN",
        "authorized_official_first_name": "YISSOCHOR",
        "authorized_official_title_or_position": "MANAGER OF SOLE MEMBER, OPA OPCO PA",
        "authorized_official_telephone_number": "908-510-8029"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Altira at Lebanon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 5TH Avenue Dental
• 900 Tuck St. Opco, LLC
• 900 Tuck Street Operations LLC
• Qais Abdiani, MD
• Maimuna Abdullahi
• Kwame Gyasi Achamfour, PHARMD
• Alexi Achenbach, MD

• Skilled Nursing Facility in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; 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.