Provider Demographics
NPI:1710057906
Name:PINE TREE A AND D
Entity Type:Organization
Organization Name:PINE TREE A AND D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-487-3113
Mailing Address - Street 1:5128 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77503-3765
Mailing Address - Country:US
Mailing Address - Phone:281-487-3113
Mailing Address - Fax:281-487-5818
Practice Address - Street 1:2514 PANSY ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77503-3926
Practice Address - Country:US
Practice Address - Phone:281-487-3113
Practice Address - Fax:281-487-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116602311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)