Provider Demographics
NPI:1457803389
Name:PINEWOOD ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:PINEWOOD ASSISTED LIVING LLC
Other - Org Name:PINEWOODS AFH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:AYUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-267-8850
Mailing Address - Street 1:2526 SW 323RD ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023
Mailing Address - Country:US
Mailing Address - Phone:253-267-8850
Mailing Address - Fax:206-212-8573
Practice Address - Street 1:2526 SW 323RD ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2520
Practice Address - Country:US
Practice Address - Phone:253-267-8850
Practice Address - Fax:206-212-8573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home