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General NPI Number Information
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NPI Number | 1902761018
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Entity Type | Organization
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Legal Business Name | RED PINE RUN LLC
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Dates
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Enumeration Date | 12/20/2025
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Last Update Date | 12/20/2025
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Provider Practice Location Address
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Address Line | 5454 COUNTY ROAD 457
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City | NEWBERRY
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State | MI
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Zip | 49868-7775
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Country | US
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Telephone | 906-869-2961
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Fax |
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Provider Business Mailing Address
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Address Line | 5454 COUNTY ROAD 457
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City | NEWBERRY
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State | MI
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Zip | 49868-7775
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWBER
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Name | HEATHER THORNTON
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Credential |
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Telephone | 906-869-2961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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