Provider Demographics
NPI:1639394117
Name:PINE RIVER INC.
Entity Type:Organization
Organization Name:PINE RIVER INC.
Other - Org Name:HEARING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN-SAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:707-426-4327
Mailing Address - Street 1:1700 PENNSYLVANIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3510
Mailing Address - Country:US
Mailing Address - Phone:707-426-4327
Mailing Address - Fax:707-426-5190
Practice Address - Street 1:1700 PENNSYLVANIA AVE STE B
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3510
Practice Address - Country:US
Practice Address - Phone:707-426-4327
Practice Address - Fax:707-426-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0004410Medicaid
CAAU0004410Medicaid
CAAU0004410Medicaid