Provider Demographics
NPI:1215203823
Name:PINEVIEW 102 LLC
Entity Type:Organization
Organization Name:PINEVIEW 102 LLC
Other - Org Name:CROSSVIEW CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:HUDSON
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-367-4563
Mailing Address - Street 1:4700 SHERIDAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3420
Mailing Address - Country:US
Mailing Address - Phone:954-367-4563
Mailing Address - Fax:954-367-4564
Practice Address - Street 1:402 EAST BAY STREET
Practice Address - Street 2:
Practice Address - City:PINEVIEW
Practice Address - State:GA
Practice Address - Zip Code:31071-3430
Practice Address - Country:US
Practice Address - Phone:229-624-2437
Practice Address - Fax:229-624-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA115541Medicare Oscar/Certification