MEDICARE: PINE HILLS, 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	310400000X	Assisted Living Facility	53872	SD

General Provider Information

NPI Number	:	1215127436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE HILLS, INC

Provider Business Mailing Address
First Line	:	1401 S TAFT AVE STE 200
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-6962
Country	:	US
Telephone Number	:	970-669-8223
Fax Number	:	970-669-8215

Provider Business Practice Location Address
First Line	:	2711 HIGHWAY 18 W
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-6602
Country	:	US
Telephone Number	:	605-745-5555
Fax Number	:	605-745-5546

Authorized Official
Title or Position	:	PRESIDENT, PINE HILLS, INC
Name	:	MR. STEVE H WYATT
Credential	:
Telephone Number	:	970-669-8223

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	07/25/2007

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Directions to “PINE HILLS, INC ” Practice Location

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