Basic Information
| Provider Information | |||||||||
| NPI: | 1528544145 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PINEHURST OPCO, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE GREENS AT PINEHURST REHABILITATION & LIVING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 AMERICA AVE UNIT 304 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087014582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326591353 | ||||||||
| FaxNumber: | 8663060259 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 RATTLESNAKE TRL | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283747639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102951781 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2018 | ||||||||
| LastUpdateDate: | 07/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | STERN | ||||||||
| AuthorizedOfficialFirstName: | JACOB | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7326591353 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH0230 | NC | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.