Provider Demographics
NPI:1689660250
Name:PINEVIEW NURSING HOME
Entity type:Organization
Organization Name:PINEVIEW NURSING HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNTY CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENO
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:715-284-0268
Mailing Address - Street 1:307 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-1744
Mailing Address - Country:US
Mailing Address - Phone:715-284-0268
Mailing Address - Fax:715-284-0278
Practice Address - Street 1:400 COUNTY ROAD R
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-5129
Practice Address - Country:US
Practice Address - Phone:715-284-5396
Practice Address - Fax:715-284-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2009-01-27
Deactivation Date:2008-04-17
Deactivation Code:
Reactivation Date:2009-01-27
Provider Licenses
StateLicense IDTaxonomies
WI2440311500000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20157000Medicaid
WI20157000Medicaid