Provider Demographics
NPI:1871707612
Name:PINE VIEW AREA, LLC
Entity type:Organization
Organization Name:PINE VIEW AREA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:
Authorized Official - Last Name:POYTHRESS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:601-408-8806
Mailing Address - Street 1:1305 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7640
Mailing Address - Country:US
Mailing Address - Phone:601-310-0250
Mailing Address - Fax:601-582-0149
Practice Address - Street 1:1305 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7640
Practice Address - Country:US
Practice Address - Phone:601-310-0250
Practice Address - Fax:601-582-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based