Organization
PINE GROVE ADULT HOME. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCENT LEROY JONES BACHELOR'S DEGREE (PRESIDENT)
(434) 531-1008
Entity
Organization
Contact information
Practice address
2609 N GARDEN LN, NORTH GARDEN, VA 22959-1636
(434) 531-1008
Mailing address
2541 N GARDEN LN, NORTH GARDEN, VA 22959-1604
(434) 531-1008
(434) 295-1185
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
IR000055
VA
Other
Enumeration date
04/09/2018
Last updated
08/17/2018
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