Pine Grove Group Home, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

069801001 Issued in VA

Legal business name

PINE GROVE GROUP HOME, LLC

Practice address

4116 Red Hill School Rd
North Garden, VA 22959-1733

Phone

(434) 295-1615

NPI assigned

Oct 18, 2017

Last updated

Jun 16, 2018By 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

Mrs. Stephanie Jane Jones, RMA

Title

Deputy Director

Phone

(434) 981-4052

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1922519826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4116 RED HILL SCHOOL RD",
            "city": "NORTH GARDEN",
            "state": "VA",
            "postal_code": "229591733",
            "telephone_number": "434-295-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4116 RED HILL SCHOOL RD",
            "city": "NORTH GARDEN",
            "state": "VA",
            "postal_code": "229591733",
            "telephone_number": "434-295-1615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE GROVE GROUP HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-18",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "434-981-4052",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RMA"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "069801001",
            "primary": true
        },
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER",
            "identifier": "0269801001",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER",
            "identifier": "0269801001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew R. Lockman, M.D.
• Celeste Pearl Delana Marsh
• Leah Neilson, LMSW
• Corrie P. Parker, FNP
• Pine Grove Adult Home. Inc

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Garden, VA
• Providers in North Garden, VA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.