Basic Information
| Provider Information | |||||||||
| NPI: | 1134545742 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NIC 15 PINES OF NEW MARKET LEASING LLC | ||||||||
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| OtherOrganizationName: | THE PINES OF NEWMARKET | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 DALLAS PKWY | ||||||||
| Address2: | 380 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750935980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4693045033 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9 GRANT RD | ||||||||
| Address2: | |||||||||
| City: | NEWMARKET | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038572195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036596000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2014 | ||||||||
| LastUpdateDate: | 03/26/2014 | ||||||||
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| AuthorizedOfficialLastName: | BOETHEL | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4693045033 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 02897 | NH | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.