Healthcare Provider Details

I. General information

NPI: 1952501892
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

6797 VALIANT DR
WINDSOR WI
53598-9513
US

V. Phone/Fax

Practice location:
  • Phone: 608-846-9316
  • Fax: 608-846-9316
Mailing address:
  • Phone: 608-846-9316
  • Fax: 608-846-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. FRED BOYD
Title or Position: CEO
Credential:
Phone: 608-846-9316