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General NPI Number Information
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NPI Number | 1710102843
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Entity Type | Organization
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Legal Business Name | PINE GARDENS ADULT CARE
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6016 PINETOWN RD
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City | OXFORD
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State | NC
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Zip | 27565-7955
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Country | US
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Telephone | 919-693-2984
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Fax | 919-603-0287
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Provider Business Mailing Address
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Address Line | 6016 PINETOWN RD
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City | OXFORD
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State | NC
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Zip | 27565-7955
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Country | US
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Telephone | 919-693-2984
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Fax | 919-603-0287
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MS. JOYCE A HARRIS
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Credential |
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Telephone | 919-693-2984
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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 | HAL-039-004
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License Number State | NC
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