# PINE MEADOWSIDENCE OPCO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pine Meadows Post Acute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134545668
- **Authorized official:** JOHN MITCHELL (SECRETARY)
- **Authorized official phone:** (385) 988-3319

## Contact information

- **Practice address:** 1608 HILL RISE DR, LEXINGTON, KY 40504-2503
- **Practice address phone:** (859) 254-2402
- **Mailing address:** 262 N UNIVERSITY AVE, FARMINGTON, UT 84025-2975

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/07/2014
- **Last updated:** 08/21/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100336110 | — | KY |