Healthcare Provider Details

I. General information

NPI: 1649365891
Provider Name (Legal Business Name): PINEVIEW HEALTH CARE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 BAY ST E
PINEVIEW GA
31071-3430
US

IV. Provider business mailing address

402 BAY ST E
PINEVIEW GA
31071-3430
US

V. Phone/Fax

Practice location:
  • Phone: 229-624-2437
  • Fax:
Mailing address:
  • Phone: 229-624-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number11561017
License Number StateGA

VIII. Authorized Official

Name: BETSY TAUNTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 229-624-2437