Op Everett, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

680602 Issued in PA

Legal business name

OP EVERETT, LLC

Doing business as

Pennknoll Village

Practice address

208 Pennknoll Rd
Everett, PA 15537-6940

Phone

(814) 623-3200

Fax

(814) 623-3202

NPI assigned

Jun 8, 2006

Organization subpart

No

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

Authorized official

Name

Joseph Conte

Title

Chief Operating Officer

Phone

(407) 571-1550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pennknoll Village Doing business as

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750321535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CONCOURSE PKWY S",
            "address_2": "SUITE 200",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327516148",
            "telephone_number": "407-571-1550",
            "fax_number": "407-571-1599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 PENNKNOLL RD",
            "city": "EVERETT",
            "state": "PA",
            "postal_code": "155376940",
            "telephone_number": "814-623-3200",
            "fax_number": "814-623-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OP EVERETT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CONTE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "407-571-1550"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "680602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012268000001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pennknoll Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alysha Norris
• Cassidy Skye Nouse, MS, RDN, LDN
• Mark Oherrick
• Jeremy Oldham
• Kylee Oldham
• Vanessa I Orris, MSN, FNP-C
• Daniel Justin Parks, CRNA
• Arpankumar Patel, MD
• Maitri Patel, DPM
• Sureschandra Patel

• Skilled Nursing Facility in Everett, PA
• Providers in Everett, 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 Aug 22, 2020; 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.