Provider Demographics
NPI:1457438863
Name:PINEVIEW COMMONS, LLC
Entity Type:Organization
Organization Name:PINEVIEW COMMONS, LLC
Other - Org Name:PINEVIEW COMMONS HOME FOR ADULTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLLLMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:518-762-5488
Mailing Address - Street 1:201 S MELCHER ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2820
Mailing Address - Country:US
Mailing Address - Phone:518-762-5488
Mailing Address - Fax:518-762-5583
Practice Address - Street 1:201 S MELCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2820
Practice Address - Country:US
Practice Address - Phone:518-762-5488
Practice Address - Fax:518-762-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280-F-034311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01726998Medicaid
NY02066773Medicaid
NY02205012Medicaid