Healthcare Provider Details

I. General information

NPI: 1861692709
Provider Name (Legal Business Name): PINE VIEW LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 N 76TH ST
MILWAUKEE WI
53218-5342
US

IV. Provider business mailing address

605 WOOD VIOLET LN
SUN PRAIRIE WI
53590-3301
US

V. Phone/Fax

Practice location:
  • Phone: 414-466-2257
  • Fax: 414-466-0919
Mailing address:
  • Phone: 608-837-6018
  • Fax: 608-834-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. FRED BOYD
Title or Position: CEO
Credential:
Phone: 608-837-6018