Provider Demographics
NPI:1578328423
Name:PINE STREET ALF OPERATIONS LLC
Entity Type:Organization
Organization Name:PINE STREET ALF OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEREL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-439-3991
Mailing Address - Street 1:8123 NW 161ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6659
Mailing Address - Country:US
Mailing Address - Phone:732-439-3991
Mailing Address - Fax:
Practice Address - Street 1:725 S PINE ST
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-3654
Practice Address - Country:US
Practice Address - Phone:863-385-0161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility