Provider Demographics
NPI:1811710692
Name:PINE MOUNTAIN RIDGE AFH LLC
Entity type:Organization
Organization Name:PINE MOUNTAIN RIDGE AFH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-845-1648
Mailing Address - Street 1:590 PINE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98903-9157
Mailing Address - Country:US
Mailing Address - Phone:509-845-1648
Mailing Address - Fax:
Practice Address - Street 1:590 PINE MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-9157
Practice Address - Country:US
Practice Address - Phone:509-845-1648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home