=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083403539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINEVILLE NURSING HOME MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2025
-----------------------------------------------------
Last Update Date | 05/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 RIVERVIEW AVE
-----------------------------------------------------
City | PINEVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40977-1452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-337-3051
-----------------------------------------------------
Fax | 606-654-2519
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1625 NICHOLASVILLE RD APT 201
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40503-1446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-230-0206
-----------------------------------------------------
Fax | 606-654-2519
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | YALINIE WIGNAKUMAR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 859-230-0206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------