Provider Demographics
NPI:1538660121
Name:PINEWOOD MANOR OF NC INC
Entity Type:Organization
Organization Name:PINEWOOD MANOR OF NC INC
Other - Org Name:PINEWOOD MANOR ASSISTED LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:EKWY
Authorized Official - Last Name:OGBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-497-0114
Mailing Address - Street 1:205 BUNN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-2705
Mailing Address - Country:US
Mailing Address - Phone:919-497-0114
Mailing Address - Fax:
Practice Address - Street 1:205 BUNN RD
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2705
Practice Address - Country:US
Practice Address - Phone:919-497-0114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home