1578927588 NPI number — PINEVIEW EXTENDED CARE CENTRE, INC.

Table of content: (NPI 1578927588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578927588 NPI number — PINEVIEW EXTENDED CARE CENTRE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINEVIEW EXTENDED CARE CENTRE, 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:
1578927588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8028 RITCHIE HWY
Provider Second Line Business Mailing Address:
SUITE 210B
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21122-1075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-766-1995
Provider Business Mailing Address Fax Number:
410-461-6095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9016 PINE VIEW LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-3229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-647-0015
Provider Business Practice Location Address Fax Number:
410-647-0019
Provider Enumeration Date:
04/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FINGLASS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
410-766-1995

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  16-032 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3007022 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com