Pine Forrest Farm Inc

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL030028 Issued in NC

Legal business name

PINE FORREST FARM INC

Practice address

4190 NC Highway 801 N
Mocksville, NC 27028-6234

Phone

(336) 998-3480

Fax

(336) 998-0177

NPI assigned

Apr 12, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Emanuel Eugene Bonaparte

Title

Executive Director

Phone

(828) 615-7030

Specialties & licenses 1

Addresses

Other names 1

• Pine Forrest Residential Care Doing business as

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902020662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 NC HIGHWAY 801 N",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270286234",
            "telephone_number": "336-998-3480",
            "fax_number": "336-998-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 NC HIGHWAY 801 N",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270286234",
            "telephone_number": "336-998-3480",
            "fax_number": "336-998-0177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE FORREST FARM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BONAPARTE",
        "authorized_official_first_name": "EMANUEL",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "828-615-7030",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL030028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Forrest Residential Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paul D. Mighion,DDS and Associates, P.a.
• Holly Payne
• My-Khanh Phan, D.D.S.
• Piedmont Healthcare, PA
• Piedmont Healthcare, PA
• Shamika Yolanda Pompey, MSW, LCSW-A
• John Naylor Price, MD
• Gary Edward Prillaman, DDS
• Hannah Prillaman, LCMHCA
• Proactive MD NC, PC

• All providers in Mocksville, NC
• Emotionally Disturbed Childrens' Residential Treatment Facility in North 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.