Provider Demographics
NPI:1396295531
Name:PINE FLAT RANCH, INC.
Entity type:Organization
Organization Name:PINE FLAT RANCH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HOLEWINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-843-3851
Mailing Address - Street 1:170 FARMERS LN STE 11
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4750
Mailing Address - Country:US
Mailing Address - Phone:707-843-3851
Mailing Address - Fax:707-595-3227
Practice Address - Street 1:170 FARMERS LN STE 11
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4750
Practice Address - Country:US
Practice Address - Phone:707-843-3851
Practice Address - Fax:707-595-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHCO494700016253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care