Provider Demographics
NPI:1801406772
Name:PINE FOREST HEALTHCARE, INC.
Entity Type:Organization
Organization Name:PINE FOREST HEALTHCARE, INC.
Other - Org Name:CAMINO HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:13922 CERISE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-8118
Mailing Address - Country:US
Mailing Address - Phone:310-675-3304
Mailing Address - Fax:310-675-4389
Practice Address - Street 1:13922 CERISE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-8118
Practice Address - Country:US
Practice Address - Phone:310-675-3304
Practice Address - Fax:310-675-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility