Healthcare Provider Details

I. General information

NPI: 1710856638
Provider Name (Legal Business Name): PINE HAVEN SNF OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 SAINT STEPHENS RD
EIGHT MILE AL
36613-3508
US

IV. Provider business mailing address

365 ROUTE 59 STE 211
AIRMONT NY
10952-3473
US

V. Phone/Fax

Practice location:
  • Phone: 251-452-0996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: YEHUDA HERZ
Title or Position: MANAGING PARTNER
Credential:
Phone: 551-795-7270