Healthcare Provider Details

I. General information

NPI: 1447586805
Provider Name (Legal Business Name): PINECREST SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 OLD JACKSONVILLE RD
TYLER TX
75701-8510
US

IV. Provider business mailing address

2225 E RANDOL MILL RD STE 630
ARLINGTON TX
76011-6315
US

V. Phone/Fax

Practice location:
  • Phone: 903-561-2011
  • Fax:
Mailing address:
  • Phone: 817-607-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ZEVI KOHN
Title or Position: CFO
Credential:
Phone: 917-370-9063