| Organization Name: | PINEBROOK RESIDENTIAL CENTER 1 |
| NPI Number: | 1184769317 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FRED H. LEONARD (PRESIDENT) |
| Mailing Address: | 312 Harrison Ave Yadkinville |
| State: | NC US |
| Postal Code: | 270558247 |
| Phone Number: | 8286553222 |
| Fax Number: | 3366797500 |
| NPI Enumeration Date: | 02/21/2007 |
| NPI Last Update Date: | 05/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 311ZA0620X |
| License Number: | HAL-099-009 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Custodial Care Facility |
| Taxonomy Specialization: | Adult Care Home |
| Taxonomy Definition: | A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |