Healthcare Provider Details

I. General information

NPI: 1184712580
Provider Name (Legal Business Name): ST. JOSEPH OF THE PINES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GOSSMAN RD
SOUTHERN PINES NC
28387-2225
US

IV. Provider business mailing address

100 GOSSMAN RD SUITE B
SOUTHERN PINES NC
28387-2224
US

V. Phone/Fax

Practice location:
  • Phone: 910-246-1000
  • Fax: 910-246-1333
Mailing address:
  • Phone: 910-246-3000
  • Fax: 910-246-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0589
License Number StateNC

VIII. Authorized Official

Name: PAMELA LATOVICK
Title or Position: VP REIMBURSEMENT
Credential:
Phone: 734-343-6628