| Pine Grove Adult Home& Care, Inc | |
|
2609 North Garden Lane Noth Garden VA 22959 | |
| (434) 295-4408 | |
| (434) 295-1185 |
| Full Name | Pine Grove Adult Home& Care, Inc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2609 North Garden Lane, Noth Garden, Virginia |
| Authorized Official Name and Position | Vincent Leroy Jones (PRESIDENT) |
| Authorized Official Contact | 4345311008 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Grove Adult Home& Care, Inc 2609 North Garden Lane Noth Garden VA 22959 Ph: (434) 295-4408 | Pine Grove Adult Home& Care, Inc 2609 North Garden Lane Noth Garden VA 22959 Ph: (434) 295-4408 |
| NPI Number | 1740683671 |
|---|---|
| Provider Enumeration Date | 10/07/2014 |
| Last Update Date | 10/07/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740683671 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | ALF1078422 (Virginia) | Primary |