Healthcare Provider Details

I. General information

NPI: 1588840904
Provider Name (Legal Business Name): PINEHURST EAST INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46100 SCHOENHERR RD
SHELBY TOWNSHIP MI
48315-5344
US

IV. Provider business mailing address

46100 SCHOENHERR RD
SHELBY TOWNSHIP MI
48315-5344
US

V. Phone/Fax

Practice location:
  • Phone: 586-566-1100
  • Fax: 586-566-1850
Mailing address:
  • Phone: 586-566-1100
  • Fax: 586-566-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number504014
License Number StateMI

VIII. Authorized Official

Name: MR. JOHN DALE BELL
Title or Position: GENERAL PARTNER
Credential:
Phone: 248-647-2900