Healthcare Provider Details

I. General information

NPI: 1528544145
Provider Name (Legal Business Name): PINEHURST OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 RATTLESNAKE TRL
PINEHURST NC
28374-7639
US

IV. Provider business mailing address

15 AMERICA AVE UNIT 304
LAKEWOOD NJ
08701-4582
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-1781
  • Fax:
Mailing address:
  • Phone: 732-659-1353
  • Fax: 866-306-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0230
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JACOB S. STERN
Title or Position: MANAGER
Credential:
Phone: 732-659-1353