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General NPI Number Information
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NPI Number | 1073550489
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Entity Type | Organization
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Legal Business Name | PINEWOOD HEALTHCARE LLC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 2514 N 7TH ST
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3720
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Country | US
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Telephone | 208-664-8128
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Fax | 208-765-0505
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Provider Business Mailing Address
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Address Line | 2514 N 7TH ST
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3720
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Country | US
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Telephone | 208-664-8128
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Fax | 208-765-0505
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Authorized Official
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Title or Position | MANAGER
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Name | MASON A. HUNTER
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Credential |
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Telephone | 208-664-8128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 33
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License Number State | ID
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