MEDICARE: PINES NURSING HOME 2015, 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
1	314000000X	Skilled Nursing Facility	1442096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326423682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINES NURSING HOME 2015, LLC

Provider Business Mailing Address
First Line	:	1815 PURDY AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-1425
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 NE 141ST ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-2837
Country	:	US
Telephone Number	:	786-877-6449
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. MEIR COSIOL
Credential	:
Telephone Number	:	786-877-6449

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	07/28/2015

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