| NPI | 1841247376 |
|---|---|
| Doing Business As | PINE LODGE CENTER |
| Entity Type | Organization |
| Authorized Contact | MICHAEL BERG Assistant Secretary 505-821-3355 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: WV 18) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: WV 18) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2015-07-13 |