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General NPI Number Information
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NPI Number | 1043410988
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Entity Type | Organization
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Legal Business Name | PINE VIEW LIVING, INC.
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4532 N 76TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53218-5341
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Country | US
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Telephone | 414-527-4039
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Fax | 414-466-0919
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Provider Business Mailing Address
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Address Line | 4532 N 76TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53218-5341
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Country | US
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Telephone | 414-527-4039
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Fax | 414-466-0919
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Authorized Official
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Title or Position | CEO
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Name | MR. FRED BOYD
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Credential |
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Telephone | 414-527-4039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | WI
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