Pine Crest Manor K&V Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL7613 Issued in FL

Legal business name

PINE CREST MANOR K&V INC

Practice address

2835 County Road 220
Middleburg, FL 32068-4205

Phone

(904) 272-2609

NPI assigned

Jun 14, 2013

Last updated

Jun 14, 2013By 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. Veerasamy Veeramah, RN

Title

Asst. Administrator

Phone

(904) 272-2609

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1371168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371168000000",
    "number": "1811335631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2835 COUNTY ROAD 220",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320684205",
            "telephone_number": "904-272-2609",
            "fax_number": "904-731-0531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 COUNTY ROAD 220",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320684205",
            "telephone_number": "904-272-2609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE CREST MANOR K&V INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-14",
        "last_updated": "2013-06-14",
        "status": "A",
        "authorized_official_last_name": "VEERAMAH",
        "authorized_official_first_name": "VEERASAMY",
        "authorized_official_title_or_position": "ASST. ADMINISTRATOR",
        "authorized_official_telephone_number": "904-272-2609",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL7613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1412272",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Middleburg, FL
• Providers in Middleburg, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; 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.