MEDICARE: PINE VALLEY ADULT CARE HOME

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	320700000X	Physical Disabilities Residential Treatment Facility	HAL 026048	NC

General Provider Information

NPI Number	:	1982739488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE VALLEY ADULT CARE HOME

Provider Business Mailing Address
First Line	:	PO BOX 35534
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-0534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3522 CAMDEN RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-7717
Country	:	US
Telephone Number	:	910-425-8954
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTATOR
Name	:	ARETTA ROBINSON
Credential	:
Telephone Number	:	910-527-9898

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/22/2020

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Directions to “PINE VALLEY ADULT CARE HOME ” Practice Location

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