Organization
PINE RIDGE MEDICAL SUPPLY
Active
Parent organization
PINE RIDGE-PINE VILLAGE RES. HOMES, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
PINE RIDGE-PINE VILLAGE RES. HOMES, INC.
Authorized official
MRS. VERNA L. GOECKE (PRESSIDENT/ADMINISTRATOR)
(513) 724-3460
Entity
Organization
Contact information
Practice address
146 N 3RD ST, WILLIAMSBURG, OH 45176-1322
(513) 724-3460
(513) 724-3462
Mailing address
146 N 3RD ST, P.O. BOX 408, WILLIAMSBURG, OH 45176-1322
(513) 724-3460
(513) 724-3462
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Enumeration date
12/06/2010
Last updated
12/06/2010
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