# BOLIVAR OPERATOR LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pine Meadows Healthcare and Rehabilitation Center, Pine Meadows Healthcare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316018286
- **Authorized official:** MR. STACEY PAUL ROGERS (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (502) 429-8062

## Contact information

- **Practice address:** 700 NUCKOLLS RD, BOLIVAR, TN 38008-1531
- **Practice address phone:** (731) 658-4707
- **Practice address fax:** (731) 658-4769
- **Mailing address:** 7400 NEW LA GRANGE RD, SUITE \#100, LOUISVILLE, KY 40222-4870
- **Mailing address phone:** (502) 429-8062
- **Mailing address fax:** (502) 429-0650

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 171 | TN | Yes |

## Other

- **Enumeration date:** 11/13/2006
- **Last updated:** 04/13/2020