Healthcare Provider Details

I. General information

NPI: 1639894934
Provider Name (Legal Business Name): PINES NURSING AND REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 DUTCHMANS LN
EASTON MD
21601-3346
US

IV. Provider business mailing address

28 ROOSEVELT AVE
LAKEWOOD NJ
08701-5654
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-4000
  • Fax:
Mailing address:
  • Phone: 732-744-4611
  • 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: YECHIEL HIRTH
Title or Position: CEO
Credential:
Phone: 732-744-4611