Provider Demographics
NPI:1114789237
Name:PINE TREE HEALTH
Entity type:Organization
Organization Name:PINE TREE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:BADR
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHEED
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:267-971-6128
Mailing Address - Street 1:6501 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-3604
Mailing Address - Country:US
Mailing Address - Phone:267-971-6128
Mailing Address - Fax:
Practice Address - Street 1:6501 N 13TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-3604
Practice Address - Country:US
Practice Address - Phone:267-971-6128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINE TREE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)