Provider Demographics
NPI:1184712580
Name:ST. JOSEPH OF THE PINES, INC
Entity type:Organization
Organization Name:ST. JOSEPH OF THE PINES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-343-6628
Mailing Address - Street 1:100 GOSSMAN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2224
Mailing Address - Country:US
Mailing Address - Phone:910-246-3000
Mailing Address - Fax:910-246-3187
Practice Address - Street 1:103 GOSSMAN RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2225
Practice Address - Country:US
Practice Address - Phone:910-246-1000
Practice Address - Fax:910-246-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0589314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00919OtherBLUECROSS BLUESHIELD
NC3405044Medicaid
NC3405044Medicaid