Provider Demographics
NPI:1003468281
Name:THE PINE TREE OF PASADENA LLC
Entity Type:Organization
Organization Name:THE PINE TREE OF PASADENA LLC
Other - Org Name:THE PINE TREE OF PASADENA, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-487-3113
Mailing Address - Street 1:5128 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77503-3765
Mailing Address - Country:US
Mailing Address - Phone:281-487-3113
Mailing Address - Fax:832-230-8711
Practice Address - Street 1:5128 PINE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77503-3765
Practice Address - Country:US
Practice Address - Phone:281-487-3113
Practice Address - Fax:832-230-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility