Provider Demographics
NPI:1326423682
Name:PINES NURSING HOME 2015, LLC
Entity Type:Organization
Organization Name:PINES NURSING HOME 2015, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MEIR
Authorized Official - Middle Name:
Authorized Official - Last Name:COSIOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-877-6449
Mailing Address - Street 1:1815 PURDY AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 NE 141ST ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-2837
Practice Address - Country:US
Practice Address - Phone:786-877-6449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1442096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility