Healthcare Provider Details

I. General information

NPI: 1184008237
Provider Name (Legal Business Name): PINES VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 09/05/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 ROUTE 530
WHITING NJ
08759-3145
US

IV. Provider business mailing address

509 ROUTE 530
WHITING NJ
08759-3145
US

V. Phone/Fax

Practice location:
  • Phone: 732-849-0400
  • Fax: 732-350-0540
Mailing address:
  • Phone: 732-849-0400
  • Fax: 732-350-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number656000
License Number StateNJ

VIII. Authorized Official

Name: KATHLEEN M MILLER
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 732-849-2011