Provider Demographics
NPI:1497752455
Name:PINE VIEW NURSING & CONVALESCENT HOME
Entity Type:Organization
Organization Name:PINE VIEW NURSING & CONVALESCENT HOME
Other - Org Name:PINE VIEW NURSING & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-643-2712
Mailing Address - Street 1:400 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26362-1150
Mailing Address - Country:US
Mailing Address - Phone:304-643-2712
Mailing Address - Fax:304-643-4979
Practice Address - Street 1:400 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26362-1150
Practice Address - Country:US
Practice Address - Phone:304-643-2712
Practice Address - Fax:304-643-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003828000Medicaid
WV515184Medicare ID - Type Unspecified