Provider Demographics
NPI:1528544145
Name:PINEHURST OPCO, LLC
Entity Type:Organization
Organization Name:PINEHURST OPCO, LLC
Other - Org Name:THE GREENS AT PINEHURST REHABILITATION & LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:S
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-659-1353
Mailing Address - Street 1:15 AMERICA AVE UNIT 304
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4582
Mailing Address - Country:US
Mailing Address - Phone:732-659-1353
Mailing Address - Fax:866-306-0259
Practice Address - Street 1:205 RATTLESNAKE TRL
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7639
Practice Address - Country:US
Practice Address - Phone:910-295-1781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0230314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility