=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457438863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINEVIEW COMMONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 02/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 S MELCHER ST
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12095-2820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-762-5488
-----------------------------------------------------
Fax | 518-762-5583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 S MELCHER ST
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12095-2820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-762-5488
-----------------------------------------------------
Fax | 518-762-5583
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. KARA VOLLLMER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 518-762-5488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | 280-F-034
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------