Provider Demographics
NPI:1063308872
Name:PINE NEEDLE OF GREENVILLE
Entity type:Organization
Organization Name:PINE NEEDLE OF GREENVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-293-1141
Mailing Address - Street 1:3590B PELHAM PKWY STE 219
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2034
Mailing Address - Country:US
Mailing Address - Phone:205-586-0056
Mailing Address - Fax:
Practice Address - Street 1:600 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-1325
Practice Address - Country:US
Practice Address - Phone:334-382-3757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility