Provider Demographics
NPI:1952501892
Name:PINE VIEW LIVING, INC.
Entity Type:Organization
Organization Name:PINE VIEW LIVING, INC.
Other - Org Name:PINE VIEW OF WINDSOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-846-9316
Mailing Address - Street 1:6797 VALIANT DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:WI
Mailing Address - Zip Code:53598-9513
Mailing Address - Country:US
Mailing Address - Phone:608-846-9316
Mailing Address - Fax:608-846-9316
Practice Address - Street 1:4525 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-5342
Practice Address - Country:US
Practice Address - Phone:608-846-9316
Practice Address - Fax:608-846-9316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities