Organization
PINE HAVEN 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
1108 N HERRITAGE ST, KINSTON, NC 28501-3834
(252) 523-1963
(252) 523-1123
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
—
3408724
—
NC
Enumeration date
04/16/2008
Last updated
04/16/2008
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