MEDICARE: PINEHAVEN HOME HEALTH CARE SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003088865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINEHAVEN HOME HEALTH CARE SERVICES INC

Provider Business Mailing Address
First Line	:	1108 N HERRITAGE ST
Second Line	:
City	:	KINSTON
State	:	NC
Zip	:	28501-3834
Country	:	US
Telephone Number	:	252-523-1963
Fax Number	:	252-523-1123

Provider Business Practice Location Address
First Line	:	6818 NC HIGHWAY 55 E
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28560-5644
Country	:	US
Telephone Number	:	252-745-1100
Fax Number	:	252-745-4185

Authorized Official
Title or Position	:	MANAGER
Name	:	L BERNARD RUSSELL
Credential	:
Telephone Number	:	252-523-1963

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	04/01/2008

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