Enchanted Pines, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

000617 Issued in TX

Legal business name

ENCHANTED PINES, INC.

Doing business as

Enchanted Pines

Practice address

1154 E Loop 304
Crockett, TX 75835-1810

Phone

(936) 544-5065

Fax

(936) 546-2694

NPI assigned

Aug 28, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Catherine McCall

Title

Administrator

Phone

(936) 545-6889

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Enchanted Pines Doing business as

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

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414972800000",
    "number": "1740474261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1154 E LOOP 304",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351810",
            "telephone_number": "936-544-5065",
            "fax_number": "936-546-5674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1154 E LOOP 304",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351810",
            "telephone_number": "936-544-5065",
            "fax_number": "936-546-2694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENCHANTED PINES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-28",
        "last_updated": "2014-11-03",
        "status": "A",
        "authorized_official_last_name": "MCCALL",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "936-545-6889",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "000617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001004039",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001004040",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Enchanted Pines",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Crockett, TX
• Providers in Crockett, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2014; 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.