Provider Demographics
NPI:1487760765
Name:PINEY PARTNERS LP
Entity type:Organization
Organization Name:PINEY PARTNERS LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:COTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-352-2721
Mailing Address - Street 1:6375 CHAMBERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17222-8350
Mailing Address - Country:US
Mailing Address - Phone:717-352-2721
Mailing Address - Fax:717-352-2142
Practice Address - Street 1:6375 CHAMBERSBURG RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17222-8350
Practice Address - Country:US
Practice Address - Phone:717-352-2721
Practice Address - Fax:717-352-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA420102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001805560-0001Medicaid
PA001805560-0001Medicaid