CMS-1500 Box 24J / 33a • NPI
1700733748
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
314000000X (CMS A1[8])
Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)
Box 32 Service Location & ZIP+4
1104 WELSH RD, PHILADELPHIA, PA, 19115-3730
✓ 9-Digit EDI 837 ZIP+4 (19115-3730)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1700733748 (1104 WELSH ROAD OPCO, LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1700733748 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | 1104 WELSH ROAD OPCO, LLC |
| Plain-English Specialty | Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF) NUCC Code: 314000000X (Skilled Nursing Facility) |
| Certifying / Licensing Body | CMS Five-Star Quality Rating System / State Department of Health |
| Practice Location Address | 1104 WELSH RD, PHILADELPHIA, PA, 19115-3730 |
| Practice Telephone / Fax | Tel: (323) 928-9445 |
| Administrative Mailing Address | 9526 W PICO BLVD, LOS ANGELES, CA, 90035-1202 |
| Enumeration & Last Sync | Enumerated: 2026-03-10 | CMS Record Updated: 2026-03-10 |
| Authorized Official | AVROHOM TRESS (Executive Vice President) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (314000000X)
What Does Taxonomy Code 314000000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 314000000X translates to:
"Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (1104 WELSH ROAD OPCO, LLC)
Typical CPT / Diagnostic Procedures:- 24-Hour Skilled Nursing Supervision, Enteral Nutrition & Pressure Ulcer Prevention
- Post-Acute Orthopedic, Cardiac & Neurological Inpatient Rehabilitation
- Chronic Disease Maintenance Regimens, Analgesics & Thromboprophylaxis
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
314000000X — Skilled Nursing FacilityPlain English: Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF) | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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