Organization
PINEHAVEN HOME HEALTH CARE SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
L BERNARD RUSSELL (MANAGER)
(252) 523-1963
Entity
Organization
Contact information
Practice address
2625 RAILROAD ST, WINTERVILLE, NC 28590-1459
(252) 355-1001
(252) 355-2205
Mailing address
1108 N HERRITAGE ST, KINSTON, NC 28501-3834
(252) 523-1963
(252) 523-1123
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6600841
—
NC
Enumeration date
04/02/2008
Last updated
04/02/2008
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