| Entity Name: | PINECREST CONVALESCENT CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Apr 2000 (25 years ago) |
| Document Number: | L00000004382 |
| FEI/EIN Number | 651002398 |
| Address: | 13650 NE 3RD CT, NORTH MIAMI, FL, 33161 |
| Mail Address: | 13650 NE 3RD CT, NORTH MIAMI, FL, 33161 |
| ZIP code: | 33161 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871503417 | 2006-08-08 | 2015-01-27 | 13650 NE 3RD CT, NORTH MIAMI, FL, 331613626, US | 13650 NE 3RD CT, NORTH MIAMI, FL, 331613626, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 305-893-1170 |
| Fax | 3058992817 |
Authorized person
| Name | MR. DAVID GOLD |
| Role | ADMINISTRATOR |
| Phone | 3058931170 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 13413 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 14400961 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022575400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WEISMAN ANDREW S | Agent | 5310 NW 33RD AVENUE, FT LAUDERDALE, FL, 33309 |
| Name | Role |
|---|---|
| HBA HEALTH SYSTEMS, LLC | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000043457 | PINECREST CONVALESCENT CENTER | EXPIRED | 2011-05-05 | 2016-12-31 | No data | 13650 NE 3RD COURT, NORTH MIAMI, FL, 33161 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No data | IDV | 36C24823D0061 | 2023-02-16 | No data | No data | |||||||||||||||||||||||
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| Obligated Amount | 250000.00 |
| Potential Award Amount | 4000000.00 |
Description
| Title | ESTIMATED NURSING HOME SERVICES |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES |
Recipient Details
| Recipient | PINECREST CONVALESCENT CENTER LLC |
| UEI | C5QAL18MNJD9 |
| Recipient Address | UNITED STATES, 13650 NE 3RD CT, NORTH MIAMI, MIAMI-DADE, FLORIDA, 331613626 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
