Provider Demographics
NPI:1235339177
Name:PINE VIEW LIVING, INC.
Entity Type:Organization
Organization Name:PINE VIEW LIVING, INC.
Other - Org Name:PINE VIEW OF MADISON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-833-4813
Mailing Address - Street 1:8410 BLACKWOLF DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2622
Mailing Address - Country:US
Mailing Address - Phone:608-833-4813
Mailing Address - Fax:608-833-7587
Practice Address - Street 1:4525 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-5342
Practice Address - Country:US
Practice Address - Phone:414-466-2257
Practice Address - Fax:414-466-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility