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Organization
PINE GROVE GROUP HOME, LLC
Active
Organization
PINE GROVE GROUP HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE JANE JONES RMA (DEPUTY DIRECTOR)
(434) 981-4052
Entity
Organization
Contact information
Practice address
4116 RED HILL SCHOOL RD, NORTH GARDEN, VA 22959-1733
(434) 295-1615
Mailing address
4116 RED HILL SCHOOL RD, NORTH GARDEN, VA 22959-1733
(434) 295-1615
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
069801001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0269801001
PROVIDER
VA
Enumeration date
10/18/2017
Last updated
06/16/2018
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