Provider Demographics
NPI:1215059100
Name:WEAVER PINEVIEW HOME
Entity type:Organization
Organization Name:WEAVER PINEVIEW HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-398-4824
Mailing Address - Street 1:142 W LEWISTOWN RD
Mailing Address - Street 2:144 WEST LEWISTOWN RD.
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-9326
Mailing Address - Country:US
Mailing Address - Phone:252-398-4824
Mailing Address - Fax:252-398-5084
Practice Address - Street 1:142 W LEWISTOWN RD
Practice Address - Street 2:144 WEST LEWISTOWN RD
Practice Address - City:MURFREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27855-9326
Practice Address - Country:US
Practice Address - Phone:252-398-4824
Practice Address - Fax:252-398-5084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL046013311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802536Medicaid
NC7802618Medicaid