| NPI | 1639170319 |
|---|---|
| Doing Business As | PINE LAKE NURSING HOME |
| Entity Type | Organization |
| Authorized Contact | JOSEPH D. MITCHELL President 850-386-2522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2008-01-08 |