1669616470 NPI number — PINEWOOD HEALTH AND REHABILITATION, LLC

Table of content: (NPI 1669616470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669616470 NPI number — PINEWOOD HEALTH AND REHABILITATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINEWOOD HEALTH AND REHABILITATION, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669616470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1423 CLARKVIEW RD
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21209-2134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-427-2700
Provider Business Mailing Address Fax Number:
414-815-5558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 WATERWELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSSETT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71635-4152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-364-5721
Provider Business Practice Location Address Fax Number:
870-364-7680
Provider Enumeration Date:
04/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
REYNOLDS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
410-513-8738

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com