Organization
BLACK PINE REAL ESTATE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL N KLOTZ OWNER (OWNER)
(812) 287-2032
Entity
Organization
Contact information
Practice address
6908 S STATE ROAD 66, LEAVENWORTH, IN 47137-8308
(812) 287-2032
Mailing address
6908 S STATE ROAD 66, LEAVENWORTH, IN 47137-8308
(812) 287-2032
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
10/22/2025
Last updated
10/22/2025
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