Provider Demographics
NPI:1174992622
Name:PINEWOOD ESTATES ASSISTED LIVING FACILITY
Entity type:Organization
Organization Name:PINEWOOD ESTATES ASSISTED LIVING FACILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:FELLOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-376-4043
Mailing Address - Street 1:PO BOX 640902
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33164-0902
Mailing Address - Country:US
Mailing Address - Phone:786-376-4043
Mailing Address - Fax:
Practice Address - Street 1:4055 PINEWOOD RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-9053
Practice Address - Country:US
Practice Address - Phone:786-376-4043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINEWOOD ESTATES ASSISTED LIVING FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL126783104A0625X, 311500000X, 385H00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No385H00000XRespite Care FacilityRespite Care