Basic Information
| Provider Information | |||||||||
| NPI: | 1639894934 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINES NURSING AND REHAB, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 ROOSEVELT AVE | ||||||||
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| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087015654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327444611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 DUTCHMANS LN | ||||||||
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| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216013346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108224000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2022 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | HIRTH | ||||||||
| AuthorizedOfficialFirstName: | YECHIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7327444611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.