Organization
1639 OPCO, LLC
Active
Other names
Independence Hall
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT CHARLES VAN FOSSAN (PRESIDENT)
(847) 917-8337
Entity
Organization
Contact information
Practice address
1639 NE 26TH ST, WILTON MANORS, FL 33305-1410
(847) 917-8337
Mailing address
1639 NE 26TH ST, WILTON MANORS, FL 33305-1410
(847) 917-8337
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
08/14/2025
Last updated
08/14/2025
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