Basic Information
| Provider Information | |||||||||
| NPI: | 1376874586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINEVIEW NURSING AND REHABILITATION CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 NEW EGYPT RD | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087012932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185353795 | ||||||||
| FaxNumber: | 7183381019 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 LOOP 304 EAST | ||||||||
| Address2: | |||||||||
| City: | CROCKETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 758350000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365442051 | ||||||||
| FaxNumber: | 9365447669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2010 | ||||||||
| LastUpdateDate: | 01/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | PINTER | ||||||||
| AuthorizedOfficialFirstName: | ESTHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7185353795 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 128429 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001014745 | 05 | TX | MEDICAID |