Basic Information
| Provider Information | |||||||||
| NPI: | 1952397739 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINE HILL NURSING AND REHABILITATION LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762014137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403874388 | ||||||||
| FaxNumber: | 9403802410 | ||||||||
| Practice Location | |||||||||
| Address1: | 1307 MARTIN LUTHER KING DR | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756571009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036653951 | ||||||||
| FaxNumber: | 9036657230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 07/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | RICH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9403874388 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 114787 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001004238 | 05 | TX | MEDICAID | 153325901 | 01 | TX | TMHP DME CROSS OVER | OTHER | 153385101 | 01 | TX | TMHP CROSS OVER | OTHER |