MEDICARE: PINEHILL SNF OPERATOR 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		GA

General Provider Information

NPI Number	:	1568956514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINEHILL SNF OPERATOR LLC

Provider Business Mailing Address
First Line	:	712 PATTERSON ST
Second Line	:
City	:	BYROMVILLE
State	:	GA
Zip	:	31007-3760
Country	:	US
Telephone Number	:	478-433-5711
Fax Number	:	478-433-4016

Provider Business Practice Location Address
First Line	:	712 PATTERSON ST
Second Line	:
City	:	BYROMVILLE
State	:	GA
Zip	:	31007-3760
Country	:	US
Telephone Number	:	478-433-5711
Fax Number	:	478-433-4016

Authorized Official
Title or Position	:	MANAGER
Name	:	BRUCE E WERTHEIM
Credential	:
Telephone Number	:	813-347-9888

Provider Enumeration Date	:	06/21/2018
Last Update Date	:	05/22/2019

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Directions to “PINEHILL SNF OPERATOR LLC ” Practice Location

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