Provider Demographics
NPI:1215127436
Name:PINE HILLS, INC
Entity type:Organization
Organization Name:PINE HILLS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PINE HILLS, INC
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-669-8223
Mailing Address - Street 1:1401 S TAFT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-6962
Mailing Address - Country:US
Mailing Address - Phone:970-669-8223
Mailing Address - Fax:970-669-8215
Practice Address - Street 1:2711 HIGHWAY 18 W
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-6602
Practice Address - Country:US
Practice Address - Phone:605-745-5555
Practice Address - Fax:605-745-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD53872310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility