1S
115 SOUTH PROVIDENCE ROAD OPCO LLC
Skilled Nursing Facility
OIG CLEARNPI VERIFIED
Location
WALLINGFORD, PA
Licensed since
2025
Rate
—
Federal identifiers
NPI registry number1083427306
Agency details
Parent orgOPA OPCO PARENT LLC
Medicare activity
StatusNo Medicare utilization on file — neutral.
Authorized official
NameYISSOCHOR KOMIN
TitleMANAGER OF SOLE MEMBER, OPA OPCO PA
Phone6105653232
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Source: NPI Registry · Last refreshed June 24, 2026