1184008237 NPI number — PINES VILLAGE, INC.

Table of content: (NPI 1184008237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184008237 NPI number — PINES VILLAGE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINES VILLAGE, INC.
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:
6
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:
1184008237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 ROUTE 530
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITING
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08759-3145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-849-0400
Provider Business Practice Location Address Fax Number:
732-350-0540
Provider Enumeration Date:
07/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
732-849-2011

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 656000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7225008 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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