MEDICARE: PINEHILL NURSING CENTER, 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	1-046-1795	GA

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

General Provider Information

NPI Number	:	1841287554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINEHILL NURSING CENTER, INC.

Provider Business Mailing Address
First Line	:	712 PATTERSON STREET
Second Line	:
City	:	BYROMVILLE
State	:	GA
Zip	:	31007
Country	:	US
Telephone Number	:	478-433-5711
Fax Number	:	478-433-4016

Provider Business Practice Location Address
First Line	:	712 PATTERSON STREET
Second Line	:
City	:	BYROMVILLE
State	:	GA
Zip	:	31007
Country	:	US
Telephone Number	:	478-433-5711
Fax Number	:	478-433-4016

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICHARD EDWARD FALLAW SR.
Credential	:
Telephone Number	:	229-268-7510

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	10/04/2007

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