Provider Demographics
NPI:1972485258
Name:PINES BOUTIQUE SERVICES, LLC
Entity type:Organization
Organization Name:PINES BOUTIQUE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:HESSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-298-0411
Mailing Address - Street 1:12222 MERIT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2282
Mailing Address - Country:US
Mailing Address - Phone:190-378-0134
Mailing Address - Fax:
Practice Address - Street 1:322 E MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-9489
Practice Address - Country:US
Practice Address - Phone:903-887-0233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health