Provider Demographics
NPI:1073550489
Name:PINEWOOD HEALTHCARE LLC
Entity Type:Organization
Organization Name:PINEWOOD HEALTHCARE LLC
Other - Org Name:COEUR D'ALENE HEALTH CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-664-8128
Mailing Address - Street 1:2514 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3720
Mailing Address - Country:US
Mailing Address - Phone:208-664-8128
Mailing Address - Fax:208-765-0505
Practice Address - Street 1:2514 N 7TH ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3720
Practice Address - Country:US
Practice Address - Phone:208-664-8128
Practice Address - Fax:208-765-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID33314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1073550489Medicaid
135052Medicare Oscar/Certification