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General NPI Number Information
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NPI Number | 1669389524
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Entity Type | Organization
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Legal Business Name | PINE LAKE FUND
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Dates
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Enumeration Date | 08/26/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 11825 PINE LAKE RD
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City | PLAINWELL
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State | MI
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Zip | 49080-9218
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Country | US
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Telephone | 269-598-0636
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Fax |
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Provider Business Mailing Address
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Address Line | 11825 PINE LAKE RD
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City | PLAINWELL
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State | MI
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Zip | 49080-9218
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Country | US
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Telephone | 269-598-0636
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. TIFFANY BETTY WHITE
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Credential | PHD
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Telephone | 269-598-0636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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