Pine Tree Villa, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100503 Issued in KY

Legal business name

PINE TREE VILLA, LLC

Practice address

4604 Lowe Rd
Louisville, KY 40220-1514

Phone

(502) 451-1401

Fax

(502) 485-1999

NPI assigned

Aug 17, 2006

Organization subpart

Yes

Parent organization

SUNBRIDGE HEALTHCARE LLCAs reported in NPPES

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

Authorized official

Name

Michael T Berg

Title

Assistant Secretary

Phone

(505) 468-4742

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Regis Woods Doing business as

Part of

Terrace Hghts Nursing H

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Sunbridge Healthcare LLC

  • Skilled Nursing Facility
  • Tuscumbia, AL
  • NPI 1285685362

  Member Of

  NPD member

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471564800000",
    "number": "1114030624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUN AVE NE",
            "address_2": "COMPLIANCE DEPARTMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094373",
            "telephone_number": "505-468-5604",
            "fax_number": "505-468-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4604 LOWE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402201514",
            "telephone_number": "502-451-1401",
            "fax_number": "502-485-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE TREE VILLA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNBRIDGE HEALTHCARE LLC",
        "enumeration_date": "2006-08-17",
        "last_updated": "2016-08-19",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4742"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KY",
            "license": "100503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12504882",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regis Woods",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas Pillitteri, APRN
• Pillpack LLC
• Brianna Pimpleton
• Ava Dorit Pinales
• Chelse Pinckney, PTA
• Erlan C Pinero, RN
• Camden Ping
• Jennifer Lynn Pinkerton
• Emily Hahn Pinkham
• Olga C Pinkston, M.D.

• Skilled Nursing Facility in Louisville, KY
• Providers in Louisville, KY by specialty
• Skilled Nursing Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.