Organization Name: | PINE MOUNTAIN NURSING HEALTH CENTER, INC. |
NPI Number: | 1285056994 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHARON M POWELL (OWNER) |
Mailing Address: | 16233 Askin Dr. Suite A Frazier Park |
State: | CA US |
Postal Code: | 932226536 |
Phone Number: | 6612422592 |
Fax Number: | |
NPI Enumeration Date: | 01/15/2014 |
NPI Last Update Date: | 06/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QC1500X |
License Number: | C3624118 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |