Provider Demographics
NPI:1871035469
Name:INTEGRITY - PINEBROOK, LLC
Entity Type:Organization
Organization Name:INTEGRITY - PINEBROOK, LLC
Other - Org Name:PINEBROOK RESIDENTIAL CENTER II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SWAIN
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-438-1383
Mailing Address - Street 1:4900 KOGER BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2738
Mailing Address - Country:US
Mailing Address - Phone:336-438-1383
Mailing Address - Fax:
Practice Address - Street 1:304 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8247
Practice Address - Country:US
Practice Address - Phone:336-679-8671
Practice Address - Fax:336-679-7500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRITY SENIOR PROPERTIES INVESTMENTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-14
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness