Pinebrook Residential Center 1

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

HAL-099-009 Issued in NC

Legal business name

PINEBROOK RESIDENTIAL CENTER 1

Practice address

312 Harrison Ave
Yadkinville, NC 27055-8247

Phone

(828) 655-3222

Fax

(336) 679-7500

NPI assigned

Feb 21, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Fred H. Leonard, MS, LPC, NC LIC. ADM

Title

President

Phone

(828) 655-3222

Specialties & licenses 1

Addresses

Tax ID family

Pinebrook Residential Center 12 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pinebrook Residential Center 2

  • Adult Care Home Facility
  • Yadkinville, NC
  • NPI 1740315837
  NPD tax ID

Locations

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462492800000",
    "number": "1184769317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 760",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270550760",
            "telephone_number": "828-655-3222",
            "fax_number": "336-679-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 HARRISON AVE",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270558247",
            "telephone_number": "828-655-3222",
            "fax_number": "336-679-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINEBROOK RESIDENTIAL CENTER 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2016-05-06",
        "status": "A",
        "authorized_official_last_name": "LEONARD",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "828-655-3222",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, LPC, NC LIC. ADM"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL-099-009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Partnership for a Drug Free NC, Inc.
• Partnership for a Drug Free NC, Inc.
• Angela Creel Peyton
• Piedmont Gastroenterology Specialists
• Piedmont Village at Yadkinville, Inc.
• Pinebrook Residential Center 2
• Wendy June Pirk, LPN
• Carl J Porchey, MD
• Luz-Hazel Maria Pyle
• Faiza Rais-Reynolds, MD

• Adult Care Home Facility in Yadkinville, NC
• Providers in Yadkinville, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.