Provider Demographics
NPI:1740752997
Name:PINE STREET HEALTHCARE PARTNERS, LLC
Entity Type:Organization
Organization Name:PINE STREET HEALTHCARE PARTNERS, LLC
Other - Org Name:PRIME HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-386-6358
Mailing Address - Street 1:4200 SEPULVEDA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4742
Mailing Address - Country:US
Mailing Address - Phone:818-386-6358
Mailing Address - Fax:818-386-6367
Practice Address - Street 1:15315 MAGNOLIA BLVD STE 401
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1175
Practice Address - Country:US
Practice Address - Phone:818-386-6358
Practice Address - Fax:818-386-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health