Provider Demographics
NPI:1053619544
Name:PINES RETIREMENT RESIDENCE, INC.
Entity type:Organization
Organization Name:PINES RETIREMENT RESIDENCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIORDANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-244-1296
Mailing Address - Street 1:2327 NW 190TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5317
Mailing Address - Country:US
Mailing Address - Phone:754-244-1296
Mailing Address - Fax:954-430-9438
Practice Address - Street 1:7740 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6966
Practice Address - Country:US
Practice Address - Phone:754-244-1296
Practice Address - Fax:954-430-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11447310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002801700OtherTREATING PROVIDER FOR MANAGED CARE PLAN FOR AMERIGROUP FLORIDA INC