Healthcare Provider Details

I. General information

NPI: 1679717474
Provider Name (Legal Business Name): PINE HILLS HEALTH AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAGNOLIA RD
CAMDEN AR
71701-4626
US

IV. Provider business mailing address

1423 CLARKVIEW RD SUITE 500
BALTIMORE MD
21209-2134
US

V. Phone/Fax

Practice location:
  • Phone: 870-836-6833
  • Fax: 870-837-2732
Mailing address:
  • Phone: 410-427-2700
  • Fax: 414-815-5558

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: MR. BRIAN K. REYNOLDS
Title or Position: MANAGER
Credential:
Phone: 410-513-8738