Provider Demographics
NPI:1396976494
Name:PINE WOODS RETREAT, INC.
Entity type:Organization
Organization Name:PINE WOODS RETREAT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD OF TRUSTEES
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NANGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-7447
Mailing Address - Street 1:1149 CORNELL AVE
Mailing Address - Street 2:SUITE 3-A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2700
Mailing Address - Country:US
Mailing Address - Phone:912-354-7447
Mailing Address - Fax:
Practice Address - Street 1:1149 CORNELL AVE
Practice Address - Street 2:SUITE 3-A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2700
Practice Address - Country:US
Practice Address - Phone:912-354-7447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)