Provider Demographics
NPI:1710256177
Name:EASTERN PINES LLC
Entity Type:Organization
Organization Name:EASTERN PINES LLC
Other - Org Name:EASTERN PINES VENT UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-446-1804
Mailing Address - Street 1:104 PENSION RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8400
Mailing Address - Country:US
Mailing Address - Phone:732-446-1804
Mailing Address - Fax:732-446-0047
Practice Address - Street 1:29 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-5561
Practice Address - Country:US
Practice Address - Phone:609-344-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN PINES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060103314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0199044Medicaid