Organization
PINE MEADOWSIDENCE OPCO, LLC
Active
Other names
Pine Meadows Post Acute
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MITCHELL (SECRETARY)
(385) 988-3319
Entity
Organization
Contact information
Practice address
1608 HILL RISE DR, LEXINGTON, KY 40504-2503
(859) 254-2402
Mailing address
262 N UNIVERSITY AVE, FARMINGTON, UT 84025-2975
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100336110
—
KY
Enumeration date
03/07/2014
Last updated
08/21/2024
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