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NPI Code Detail

MEDICARE: PINE HILLS HEALTHCARE LLC

MEDICARE: PINE HILLS HEALTHCARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1316694003
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINE HILLS HEALTHCARE LLC
Provider Business Mailing Address
First Line : 362 E KENNEDY BLVD
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1434
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 900 MAGNOLIA RD
Second Line :
City : CAMDEN
State : AR
Zip : 71701-4626
Country : US
Telephone Number : 870-836-6833
Fax Number :
Authorized Official
Title or Position : AUTHORIZED REP
Name : JACOB TAUB
Credential :
Telephone Number : 917-703-3274
Provider Enumeration Date : 03/03/2022
Last Update Date : 12/09/2025

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Directions to “PINE HILLS HEALTHCARE LLC ” Practice Location

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