Provider Demographics
NPI:1588835813
Name:THE PINES AT DAVIDSON, INC.
Entity Type:Organization
Organization Name:THE PINES AT DAVIDSON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-896-1100
Mailing Address - Street 1:400 AVINGER LN
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8800
Mailing Address - Country:US
Mailing Address - Phone:704-896-1100
Mailing Address - Fax:704-896-1119
Practice Address - Street 1:400 AVINGER LN
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8800
Practice Address - Country:US
Practice Address - Phone:704-896-1100
Practice Address - Fax:704-896-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0443313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility