Active NPI
Pine Bluff Ar Opco LLC
- Skilled Nursing Facility
- Pine Bluff, AR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- PINE BLUFF AR OPCO LLC
- Practice address
- 6301 S Hazel St
Pine Bluff, AR 71603-7818 - Phone
- (870) 534-8153
- NPI assigned
- Mar 21, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Chaim Herzberg
- Title
- Ceo
- Phone
- (347) 752-0095
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
6301 S Hazel St
Pine Bluff, AR 71603-7818
Mailing address
150 Oberlin Ave N Ste 6
Lakewood, NJ 08701-4535
Phone (732) 800-6005
Other names 1
- The Springs of Pine Bluff
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230614003811 | AR | Part A Provider - Skilled Nursing Facility | 3577921055 | Practice locations: Pine Bluff, AR |
Skilled nursing facility certification: CCN 045277
- Legal name
- PINE BLUFF AR OPCO LLC
- Doing business as
- THE SPRINGS OF PINE BLUFF
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 1, 1995
- Last certification
- Mar 28, 2024
- Beds
- 103
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Enrollment address
- 6301 S Hazel St
Pine Bluff, AR 71603-7818 - Nursing home name
- THE SPRINGS OF PINE BLUFF
- Affiliated entity
- THE SPRINGS ARKANSAS
Care Compare: Nursing home
Medicare Care Compare- Listed as
- The Springs of Pine Bluff
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- May 1, 1995
- Medicare certification status
- Active
- Certified beds
- 103
- Chain
- The Springs Arkansas
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D0883412 | Springs of Pine Bluff, the | Certificate of waiver | Mar 6, 2028 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 8
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Isaac Gutman | Adp of the SNF | Mar 31, 2023 | |
| Direct Ownership Interest | Mar 31, 2023 | 35% | |
| Jacob Taub | Adp of the SNF | Mar 31, 2023 | |
| Direct Ownership Interest | Mar 31, 2023 | 35% | |
| Suzann Wilson | Operational/Managerial Control | Jan 27, 2025 | |
| Adp of the SNF | Jan 27, 2025 | ||
| Alexander Hoffman | Adp of the SNF | Mar 31, 2023 | |
| Direct Ownership Interest | Mar 31, 2023 | 10% | |
| Red River Management LLC | Adp of the SNF | Mar 31, 2023 | |
| Chaim Y Herzberg | Operational/Managerial Control | Mar 31, 2023 | |
| Adp of the SNF | Mar 31, 2023 | ||
| Direct Ownership Interest | Mar 31, 2023 | 20% | |
| James S Cash | Operational/Managerial Control | Mar 31, 2023 | |
| Adp of the SNF | Mar 31, 2023 | ||
| Pine Bluff Propco LLC | Adp of the SNF | Mar 31, 2023 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Pine Bluff, AR
- NPI 1003826199
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Affiliated clinicians 2
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679356800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1679356800000",
"number": "1851093017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 OBERLIN AVE N STE 6",
"city": "LAKEWOOD",
"state": "NJ",
"postal_code": "087014535",
"telephone_number": "732-800-6005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6301 S HAZEL ST",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716037818",
"telephone_number": "870-534-8153"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PINE BLUFF AR OPCO LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-03-21",
"last_updated": "2023-03-21",
"certification_date": "2023-03-21",
"status": "A",
"authorized_official_last_name": "HERZBERG",
"authorized_official_first_name": "CHAIM",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "347-752-0095"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "The Springs of Pine Bluff",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Pine Bluff, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.