MEDICARE: PINES VILLAGE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility
2	310400000X	Assisted Living Facility	65A001	NJ
3	314000000X	Skilled Nursing Facility	656000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104992528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINES VILLAGE, INC.

Provider Business Mailing Address
First Line	:	509 ROUTE 530
Second Line	:
City	:	WHITING
State	:	NJ
Zip	:	08759-3145
Country	:	US
Telephone Number	:	732-849-0400
Fax Number	:	732-350-0540

Provider Business Practice Location Address
First Line	:	509 ROUTE 530
Second Line	:
City	:	WHITING
State	:	NJ
Zip	:	08759-3145
Country	:	US
Telephone Number	:	732-849-0400
Fax Number	:	732-350-0540

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BRENDEN GAROZZO
Credential	:
Telephone Number	:	732-849-0400

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	09/01/2023

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Directions to “PINES VILLAGE, INC. ” Practice Location

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