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General NPI Number Information
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NPI Number | 1326423682
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Entity Type | Organization
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Legal Business Name | PINES NURSING HOME 2015, LLC
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 301 NE 141ST ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-2837
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Country | US
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Telephone | 786-877-6449
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Fax |
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Provider Business Mailing Address
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Address Line | 1815 PURDY AVE
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City | MIAMI BEACH
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State | FL
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Zip | 33139-1425
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MEIR COSIOL
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Credential |
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Telephone | 786-877-6449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1442096
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License Number State | FL
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