Provider Demographics
NPI:1184008237
Name:PINES VILLAGE, INC.
Entity Type:Organization
Organization Name:PINES VILLAGE, INC.
Other - Org Name:THE PINES AT WHITING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-849-2011
Mailing Address - Street 1:509 ROUTE 530
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-3145
Mailing Address - Country:US
Mailing Address - Phone:732-849-0400
Mailing Address - Fax:732-350-0540
Practice Address - Street 1:509 ROUTE 530
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-3145
Practice Address - Country:US
Practice Address - Phone:732-849-0400
Practice Address - Fax:732-350-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
NJ656000314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7225008Medicaid
NJ7225008Medicaid