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General NPI Number Information
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NPI Number | 1457784662
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Entity Type | Organization
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Legal Business Name | THE PINES TREATMENT & RECOVERY CENTER
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | N3387 STATE ROAD 73
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City | WAUTOMA
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State | WI
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Zip | 54982-5257
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Country | US
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Telephone | 920-787-0818
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Fax |
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Provider Business Mailing Address
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Address Line | N3387 STATE ROAD 73
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City | WAUTOMA
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State | WI
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Zip | 54982
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Country | US
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Telephone | 920-787-0818
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN D TOMASINI
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Credential |
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Telephone | 920-787-0818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 0014457
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License Number State | WI
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