Healthcare Provider Details

I. General information

NPI: 1316698749
Provider Name (Legal Business Name): PINEVIEW HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8444 OAK RD
EVART MI
49631-8088
US

IV. Provider business mailing address

8444 OAK RD
EVART MI
49631-8088
US

V. Phone/Fax

Practice location:
  • Phone: 231-734-2045
  • Fax:
Mailing address:
  • Phone: 231-734-2045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN P COVERT
Title or Position: BILLING
Credential:
Phone: 231-492-4207