Pine River Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

294020 Issued in MI

Legal business name

PINE RIVER HEALTHCARE LLC

Doing business as

Pine River Healthcare Center

Practice address

1149 W Monroe Rd
Saint Louis, MI 48880-9736

Phone

(989) 681-3852

Fax

(989) 681-3856

NPI assigned

Jun 1, 2006

Last updated

Feb 25, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janet L. Baker

Title

Manager

Phone

(989) 681-3852

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pine River Healthcare Center Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456358400000",
    "number": "1073550885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 W MONROE RD",
            "city": "SAINT LOUIS",
            "state": "MI",
            "postal_code": "488809736",
            "telephone_number": "989-681-3852",
            "fax_number": "989-681-3856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 W MONROE RD",
            "city": "SAINT LOUIS",
            "state": "MI",
            "postal_code": "488809736",
            "telephone_number": "989-681-3852",
            "fax_number": "989-681-3856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIVER HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2016-02-25",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "989-681-3852"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "294020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4639839",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine River Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Saint Louis, MI
• Providers in Saint Louis, MI by specialty
• Skilled Nursing Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.