Provider Demographics
NPI:1467008300
Name:PINE HILL INDIAN COMMUNITY DEVELOPMENT INITIATIVE
Entity Type:Organization
Organization Name:PINE HILL INDIAN COMMUNITY DEVELOPMENT INITIATIVE
Other - Org Name:PINE HILL HEALTH NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHUM
Authorized Official - Suffix:
Authorized Official - Credentials:MSCJ/LAW, CHW
Authorized Official - Phone:803-662-3777
Mailing Address - Street 1:4055 COBURG LN
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-9014
Mailing Address - Country:US
Mailing Address - Phone:803-662-3377
Mailing Address - Fax:
Practice Address - Street 1:4631 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:NORTH
Practice Address - State:SC
Practice Address - Zip Code:29112-8180
Practice Address - Country:US
Practice Address - Phone:803-247-2534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty