Healthcare Provider Details

I. General information

NPI: 1851005540
Provider Name (Legal Business Name): M PINES OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 NE 26TH ST
WILTON MANORS FL
33305-1412
US

IV. Provider business mailing address

1076 E 23RD ST
BROOKLYN NY
11210-3638
US

V. Phone/Fax

Practice location:
  • Phone: 954-566-8353
  • Fax:
Mailing address:
  • Phone: 917-596-1800
  • 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: MR. MARK FRIEDMAN
Title or Position: MANAGER
Credential:
Phone: 917-596-1800