# PINE LODGE BUSINESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205643442
- **Authorized official:** MRS. NISSA NASIR HUSAIN (OWNER)
- **Authorized official phone:** (214) 606-0550

## Contact information

- **Practice address:** 1667 W PLANO PKWY, PLANO, TX 75075-8666
- **Practice address phone:** (214) 606-0550
- **Mailing address:** 3639 COPPER STONE DR, DALLAS, TX 75287-6257
- **Mailing address phone:** (214) 606-0550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311500000X | Alzheimer Center (Dementia Center) | — | — | Yes |

## Other

- **Enumeration date:** 12/11/2024
- **Last updated:** 12/12/2024