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General NPI Number Information
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NPI Number | 1477650752
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Entity Type | Organization
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Legal Business Name | PINEWOOD RETIREMENT VILLA, INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2 SLAPPEY DR
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City | HAWKINSVILLE
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State | GA
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Zip | 31036-1459
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Country | US
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Telephone | 478-783-1623
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Fax | 478-783-3432
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Provider Business Mailing Address
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Address Line | 2 SLAPPEY DR
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City | HAWKINSVILLE
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State | GA
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Zip | 31036-1459
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Country | US
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Telephone | 478-783-1623
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Fax | 478-783-3432
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONALD GARY CRUMP
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Credential |
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Telephone | 478-783-1623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | GA
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