Healthcare Provider Details

I. General information

NPI: 1215203823
Provider Name (Legal Business Name): PINEVIEW 102 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 EAST BAY STREET
PINEVIEW GA
31071-3430
US

IV. Provider business mailing address

4700 SHERIDAN ST SUITE B
HOLLYWOOD FL
33021-3420
US

V. Phone/Fax

Practice location:
  • Phone: 229-624-2437
  • Fax: 229-624-2715
Mailing address:
  • Phone: 954-367-4563
  • Fax: 954-367-4564

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: MS. MARGARET HUDSON FERNANDEZ
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 954-367-4563