Provider Demographics
NPI:1851093017
Name:PINE BLUFF AR OPCO LLC
Entity Type:Organization
Organization Name:PINE BLUFF AR OPCO LLC
Other - Org Name:THE SPRINGS OF PINE BLUFF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-752-0095
Mailing Address - Street 1:150 OBERLIN AVE N STE 6
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4535
Mailing Address - Country:US
Mailing Address - Phone:732-800-6005
Mailing Address - Fax:
Practice Address - Street 1:6301 S HAZEL ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7818
Practice Address - Country:US
Practice Address - Phone:870-534-8153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility