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General NPI Number Information
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NPI Number | 1619271178
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Entity Type | Organization
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Legal Business Name | THE PINES RESIDENTIAL TREATMENT CENTER INC
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Dates
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Enumeration Date | 12/27/2010
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 825 CRAWFORD PKWY
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City | PORTSMOUTH
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State | VA
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Zip | 23704-2301
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Country | US
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Telephone | 757-391-6734
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Fax |
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Provider Business Mailing Address
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Address Line | 825 CRAWFORD PKWY
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City | PORTSMOUTH
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State | VA
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Zip | 23704-2301
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Country | US
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Telephone | 757-391-6734
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Fax |
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Authorized Official
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Title or Position | SR VP CFO
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Name | STEVE FILTON
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Credential |
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Telephone | 610-768-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 90914002
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License Number State | VA
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