Healthcare Provider Details

I. General information

NPI: 1750210142
Provider Name (Legal Business Name): PINEWOOD HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 COMMERCE ST
HAWKINSVILLE GA
31036-8415
US

IV. Provider business mailing address

277 COMMERCE ST
HAWKINSVILLE GA
31036-8415
US

V. Phone/Fax

Practice location:
  • Phone: 478-892-9171
  • Fax:
Mailing address:
  • Phone: 478-892-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY PEAVY
Title or Position: ADMINISTRATOR
Credential:
Phone: 478-832-9866