Provider Demographics
NPI:1336287911
Name:PINEHAVEN, INC
Entity Type:Organization
Organization Name:PINEHAVEN, INC
Other - Org Name:PINE HAVEN HERITAGE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SLICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-574-4838
Mailing Address - Street 1:24102 JACOB MACA RD
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57745-6547
Mailing Address - Country:US
Mailing Address - Phone:605-574-4838
Mailing Address - Fax:
Practice Address - Street 1:23776 PINE HAVEN DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-7407
Practice Address - Country:US
Practice Address - Phone:605-348-2145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11046310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility