Healthcare Provider Details

I. General information

NPI: 1598656373
Provider Name (Legal Business Name): PINE OAK POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 MISSION ST
S PASADENA CA
91030-3144
US

IV. Provider business mailing address

904 MISSION ST
S PASADENA CA
91030-3144
US

V. Phone/Fax

Practice location:
  • Phone: 213-840-5585
  • Fax:
Mailing address:
  • Phone: 213-840-5585
  • 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: BARRY KOHN
Title or Position: MANAGER
Credential:
Phone: 213-840-5585