Provider Demographics
NPI:1285056994
Name:PINE MOUNTAIN NURSING HEALTH CENTER, INC.
Entity type:Organization
Organization Name:PINE MOUNTAIN NURSING HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:661-242-2592
Mailing Address - Street 1:16233 ASKIN DR.
Mailing Address - Street 2:SUITE A
Mailing Address - City:FRAZIER PARK
Mailing Address - State:CA
Mailing Address - Zip Code:93222-6536
Mailing Address - Country:US
Mailing Address - Phone:661-242-2592
Mailing Address - Fax:661-262-7031
Practice Address - Street 1:770 10TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6210
Practice Address - Country:US
Practice Address - Phone:707-826-8633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3624118261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health