Organization
PINE GROVE GROUP HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE JANE JONES RMA (DEPUTY DIRECTOR)
(434) 981-4052
Entity
Organization
Contact information
Practice address
4116 RED HILL SCHOOL RD, NORTH GARDEN, VA 22959-1733
(434) 295-1615
Mailing address
4116 RED HILL SCHOOL RD, NORTH GARDEN, VA 22959-1733
(434) 295-1615
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
069801001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0269801001
PROVIDER
VA
01
—
0269801001
PROVIDER
—
Enumeration date
10/18/2017
Last updated
06/16/2018
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