100 West Queen Street Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

100 WEST QUEEN STREET OPCO LLC

Doing business as

Altira at Inners Creek

Practice address

100 W Queen St
Dallastown, PA 17313-2133

Phone

(717) 246-1671

NPI assigned

Jan 30, 2025

Last updated

Jan 30, 2025By the provider in NPPES

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 Inners Creek 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": "1609689900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W QUEEN ST",
            "city": "DALLASTOWN",
            "state": "PA",
            "postal_code": "173132133",
            "telephone_number": "717-246-1671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W QUEEN ST",
            "city": "DALLASTOWN",
            "state": "PA",
            "postal_code": "173132133",
            "telephone_number": "717-246-1671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "100 WEST QUEEN 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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Altira at Inners Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 100 W Queen Street Operations LLC (Dallastown Skilled Nursing and Rehabilitation Center)
• 100 West Queen St. Opco, LLC
• Jennifer A Anderson, O.D.
• Rocco R Arcieri II, M.D.
• Brandon John Bishop, PA-C
• Victoria Bowman
• Deirdre Vanessa Bradley, LMT

• Skilled Nursing Facility in Dallastown, PA
• Providers in Dallastown, 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.