Organization
PINE HAVEN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE R ZILLER (ADMINISTRATOR / CEO)
(507) 356-8304
Entity
Organization
Contact information
Practice address
210 3RD ST NW, PINE ISLAND, MN 55963-9139
(507) 356-8304
(507) 356-4400
Mailing address
210 3RD ST NW, PINE ISLAND, MN 55963
(507) 356-8304
(507) 356-4400
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
334206
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
245359
MEDICARE
MN
05
—
664240300
—
MN
01
—
8791PI
BLUE CROSS BLUE SHIELD
MN
Enumeration date
03/05/2007
Last updated
06/23/2015
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