Healthcare Provider Details

I. General information

NPI: 1851093017
Provider Name (Legal Business Name): PINE BLUFF AR OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 S HAZEL ST
PINE BLUFF AR
71603-7818
US

IV. Provider business mailing address

150 OBERLIN AVE N STE 6
LAKEWOOD NJ
08701-4535
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-8153
  • Fax:
Mailing address:
  • Phone: 732-800-6005
  • 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: CHAIM HERZBERG
Title or Position: CEO
Credential:
Phone: 347-752-0095