Provider Demographics
NPI:1568956514
Name:PINEHILL SNF OPERATOR LLC
Entity Type:Organization
Organization Name:PINEHILL SNF OPERATOR LLC
Other - Org Name:PIONEER HEALTH OF CENTRAL GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WERTHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-347-9888
Mailing Address - Street 1:712 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:BYROMVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31007-3760
Mailing Address - Country:US
Mailing Address - Phone:478-433-5711
Mailing Address - Fax:478-433-4016
Practice Address - Street 1:712 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:BYROMVILLE
Practice Address - State:GA
Practice Address - Zip Code:31007-3760
Practice Address - Country:US
Practice Address - Phone:478-433-5711
Practice Address - Fax:478-433-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility