Provider Demographics
NPI:1730553553
Name:PINE VIEW TERRACE, LLC DBA DOVE HEALTHCARE TRANSPORT
Entity type:Organization
Organization Name:PINE VIEW TERRACE, LLC DBA DOVE HEALTHCARE TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:715-552-1030
Mailing Address - Street 1:1405 TRUAX BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-1474
Mailing Address - Country:US
Mailing Address - Phone:715-552-1030
Mailing Address - Fax:715-552-1033
Practice Address - Street 1:1405 TRUAX BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-1474
Practice Address - Country:US
Practice Address - Phone:715-552-1030
Practice Address - Fax:715-552-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100047491Medicaid