Healthcare Provider Details

I. General information

NPI: 1083403539
Provider Name (Legal Business Name): PINEVILLE NURSING HOME MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 RIVERVIEW AVE
PINEVILLE KY
40977-1452
US

IV. Provider business mailing address

1625 NICHOLASVILLE RD APT 201
LEXINGTON KY
40503-1446
US

V. Phone/Fax

Practice location:
  • Phone: 606-337-3051
  • Fax: 606-654-2519
Mailing address:
  • Phone: 859-230-0206
  • Fax: 606-654-2519

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: YALINIE WIGNAKUMAR
Title or Position: PRESIDENT
Credential: MD
Phone: 859-230-0206