Provider Demographics
NPI:1306410535
Name:FOUR PINES HEALTH CARE SERVICES INC
Entity Type:Organization
Organization Name:FOUR PINES HEALTH CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:AYIOKA
Authorized Official - Last Name:ONDARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-227-9722
Mailing Address - Street 1:6715 BARRED OWL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3673
Mailing Address - Country:US
Mailing Address - Phone:682-227-9722
Mailing Address - Fax:
Practice Address - Street 1:1601 E LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4510
Practice Address - Country:US
Practice Address - Phone:817-583-6661
Practice Address - Fax:817-583-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health