Healthcare Provider Details

I. General information

NPI: 1902280662
Provider Name (Legal Business Name): PINES SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 CARPENTER DAM RD
HOT SPRINGS AR
71901-8213
US

IV. Provider business mailing address

524 CARPENTER DAM RD
HOT SPRINGS AR
71901-8213
US

V. Phone/Fax

Practice location:
  • Phone: 501-262-4124
  • Fax: 501-262-5722
Mailing address:
  • Phone: 501-262-4124
  • Fax: 501-262-5722

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: ROSS PONTHIE
Title or Position: MEMBER
Credential:
Phone: 318-443-8167