Provider Demographics
NPI:1437163912
Name:PINE LEAF INVESTMENT INC.
Entity Type:Organization
Organization Name:PINE LEAF INVESTMENT INC.
Other - Org Name:QUIET OAKS HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:BUFORD
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-868-7406
Mailing Address - Street 1:125 QUIET OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30630
Mailing Address - Country:US
Mailing Address - Phone:706-743-5452
Mailing Address - Fax:706-743-5655
Practice Address - Street 1:125 QUIET OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:GA
Practice Address - Zip Code:30630
Practice Address - Country:US
Practice Address - Phone:706-743-5452
Practice Address - Fax:706-743-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-109-173314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000370851AMedicaid
GA115396Medicare Oscar/Certification