Pine Grove Inc.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

SR0008132001CCI Issued in SC

Legal business name

PINE GROVE INC.

Practice address

1500 Chestnut Road
Elgin, SC 29045-0100

Phone

(803) 438-3011

Fax

(803) 438-8611

NPI assigned

Jan 3, 2007

Last updated

Aug 22, 2020By 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

Mr. James D. Moen

Title

Executive Director

Phone

(803) 438-3011

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346307899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "ELGIN",
            "state": "SC",
            "postal_code": "290450100",
            "telephone_number": "803-438-3011",
            "fax_number": "803-438-8611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 CHESTNUT ROAD",
            "city": "ELGIN",
            "state": "SC",
            "postal_code": "290450100",
            "telephone_number": "803-438-3011",
            "fax_number": "803-438-8611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE GROVE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "803-438-3011",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "SC",
            "license": "SR0008132001CCI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "961MXH",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Talley Parrott, M.D.
• Sarah Smith Paschal, PHARMD
• Manish Prafulla Patel, M.D.
• Patient Centered Healthcare LLC (Nurse Next Door Columbia)
• Elite Pierre
• Pine Grove Opco LLC (Pine Grove)
• Aleisha Pittman
• Pontiac Pharmacy
• Susan M Postmus, P.T.
• Hollie Powell, MSPAS, PA-C

• Emotionally Disturbed Childrens' Residential Treatment Facility in Elgin, SC
• Providers in Elgin, SC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.