Pine Valley Adult Care Home

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

HAL 026048 Issued in NC

Legal business name

PINE VALLEY ADULT CARE HOME

Practice address

3522 Camden Rd
Fayetteville, NC 28306-7717

Phone

(910) 425-8954

NPI assigned

Feb 23, 2007

Organization subpart

No

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

Authorized official

Name

Aretta Robinson

Title

Administator

Phone

(910) 527-9898

Specialties & licenses 1

Addresses

Tax ID family

Brandin Manor FCH2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Brandin Manor FCH

  • Physical Disabilities Residential Treatment Facility
  • Fayetteville, NC
  • NPI 1083801534
  NPD tax ID

Locations

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982739488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35534",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283030534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3522 CAMDEN RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283067717",
            "telephone_number": "910-425-8954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE VALLEY ADULT CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "ARETTA",
        "authorized_official_title_or_position": "ADMINISTATOR",
        "authorized_official_telephone_number": "910-527-9898"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "NC",
            "license": "HAL 026048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark William Pike, DMD
• Ian D Pilcher, DDS
• James Junious Pilgrim III, CRNA
• Shelise Pilot
• Nathaniel Pinckney
• Pine Village Treatment Services
• Pine Village Treatment Services, Inc.
• Pineapple Express Transportation LLC
• Pinehurst Surgical Clinic, PA
• Imani Pinkney

• Physical Disabilities Residential Treatment Facility in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Physical Disabilities 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.