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General NPI Number Information
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NPI Number | 1285056994
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Entity Type | Organization
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Legal Business Name | PINE MOUNTAIN NURSING HEALTH CENTER, INC.
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 770 10TH ST
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City | ARCATA
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State | CA
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Zip | 95521-6210
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Country | US
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Telephone | 707-826-8633
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Fax |
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Provider Business Mailing Address
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Address Line | 16233 ASKIN DR. SUITE A
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City | FRAZIER PARK
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State | CA
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Zip | 93222-6536
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Country | US
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Telephone | 661-242-2592
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Fax | 661-262-7031
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHARON M POWELL
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Credential | FNP-C
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Telephone | 661-242-2592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | C3624118
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License Number State | CA
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