Provider Demographics
NPI:1144390311
Name:PINE TREE ASSISTED LIVING, L.P.
Entity Type:Organization
Organization Name:PINE TREE ASSISTED LIVING, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSE
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:281-487-5818
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:281-487-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116607310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014601Medicaid
TX001014061OtherDEPARTMENT OF AGING AND DISABILITY SERVICES