Provider Demographics
NPI:1225729429
Name:PINE BLUFF NURSING, LLC
Entity Type:Organization
Organization Name:PINE BLUFF NURSING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZVI
Authorized Official - Middle Name:
Authorized Official - Last Name:RHINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-420-8582
Mailing Address - Street 1:6810 S HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7828
Mailing Address - Country:US
Mailing Address - Phone:312-420-8582
Mailing Address - Fax:
Practice Address - Street 1:6810 S HAZEL ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7828
Practice Address - Country:US
Practice Address - Phone:312-420-8582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility