MEDICARE: PINE HAVEN SNF OPCO 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

General Provider Information

NPI Number	:	1710856638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE HAVEN SNF OPCO LLC

Provider Business Mailing Address
First Line	:	365 ROUTE 59 STE 211
Second Line	:
City	:	AIRMONT
State	:	NY
Zip	:	10952-3473
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 SAINT STEPHENS RD
Second Line	:
City	:	EIGHT MILE
State	:	AL
Zip	:	36613-3508
Country	:	US
Telephone Number	:	251-452-0996
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	YEHUDA HERZ
Credential	:
Telephone Number	:	551-795-7270

Provider Enumeration Date	:	10/30/2025
Last Update Date	:	10/30/2025

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