PINE GROVE INC. (NPI# 1346307899) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346307899 |
| Entity Type | Organization |
| Organization Name | PINE GROVE INC. |
| Practice Address |
1500 Chestnut Road Elgin SC 29045-0100 |
| Mailing Address |
Po Box 100 Elgin SC 29045-0100 |
| Practice Telephone | 8034383011 |
| Practice Fax Number | 8034388611 |
| Mailing Telephone | 8034383011 |
| Mailing Fax Number | 8034388611 |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. JAMES D. MOEN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8034383011 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | SR0008132001CCI | SC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 961MXH | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Pine Grove Inc. | 110 Oakwood Dr. Suite 300, Winston Salem, NC 27103 |
| Street Address |
1500 CHESTNUT ROAD |
| City | ELGIN |
| State | SC |
| Zip Code | 29045-0100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669079901 | Kelley Brown Davis | Nurse Practitioner | 2689 Us-1, Elgin, SC 29045 | 2020-10-08 |
| 1265089494 | Felicity Garrick | Occupational Therapist | 385 Spears Creek Church Road, Elign, SC 29045 | 2019-08-22 |
| 1629537303 | Traisha White Campfield | Pharmacist | 1107 Ross St, Elgin, SC 29045 | 2019-03-13 |
| 1922526722 | Talesia Jackson | Specialist/Technologist | 1127 Triple Crown Court, Elgin, SC 29045 | 2017-09-01 |
| 1649697228 | All South Case Management | Exclusive Provider Organization | 216 Sunday Silence Lane, Elgin, SC 29045 | 2014-03-21 |
| 1235481151 | Karen C. Taylor | Counselor | 2439 Main Street, Elgin, SC 29045 | 2012-10-03 |
| 1306135975 | Aftercare Medical Equipment & Supplies, Inc | Durable Medical Equipment & Medical Supplies | 1105 Ross St, Elgin, SC 29045 | 2011-04-04 |
| 1902032345 | Aftercare Home Medical Equipment Inc | Durable Medical Equipment & Medical Supplies | 1107 Ross Street, Elgin, SC 29045 | 2009-05-29 |
| 1962691592 | Pontiac Pharmacy | Pharmacy | 10535 A Two Notch Rd, Elgin, SC 29045 | 2007-10-19 |
| 1154529576 | Sarah Jones Disasa | Speech-Language Pathologist | 203 Parrish Walk, Elgin, SC 29045 | 2007-07-06 |
| Find all providers in zip 29045 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750551149 | The Larkin Center | Residential Treatment Facility, Emotionally Disturbed Children | 59 Park Row, Elgin, IL 60120-6525 | 2008-03-03 |
| 1285804518 | The Larkin Center | Residential Treatment Facility, Emotionally Disturbed Children | 60 N Melrose, Elgin, IL 60123 | 2008-03-03 |
| 1922278316 | The Larkin Center | Residential Treatment Facility, Emotionally Disturbed Children | 12 S Crystal St, Elgin, IL 60123-6339 | 2008-03-03 |
| 1417127804 | The Larkin Center | Residential Treatment Facility, Emotionally Disturbed Children | 510 W Highland Ave, Elgin, IL 60123-5428 | 2008-03-03 |
| 1003086497 | The Larkin Center | Residential Treatment Facility, Emotionally Disturbed Children | 518 W Highland Ave, Elgin, IL 60123-5428 | 2008-03-03 |
| 1194995589 | The Larkin Center | Residential Treatment Facility, Emotionally Disturbed Children | 455 N Shady Oaks Dr, Elgin, IL 60120-4309 | 2008-03-03 |
| 1194994574 | The Larkin Center | Residential Treatment Facility, Emotionally Disturbed Children | 9n987 Koshare Trl, Elgin, IL 60124-8427 | 2008-02-29 |
| 1710156195 | The Larkin Center | Residential Treatment Facility, Emotionally Disturbed Children | 152 College St, Elgin, IL 60120-5652 | 2008-02-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235797812 | Wise Care Services, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 1435 Deberry Blvd, Florence, SC 29501-5601 | 2019-05-30 |
| 1366937021 | Doors To Freedom | Residential Treatment Facility, Emotionally Disturbed Children | 1317m N Main St # 263, Summerville, SC 29483-7307 | 2018-06-26 |
| 1205297967 | Potter's House Palmetto, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 104 E Berry St, Lincolnville, SC 29485-7204 | 2016-03-09 |
| 1710342522 | New Directions | Residential Treatment Facility, Emotionally Disturbed Children | 3685 Travertine Dr, Lancaster, SC 29720-6934 | 2015-12-21 |
| 1609219906 | Billie Hardee Home for Boys | Residential Treatment Facility, Emotionally Disturbed Children | 1120 Timmonsville Hwy, Darlington, SC 29532-9998 | 2013-04-17 |
| 1205175452 | S.c Department of Juvenile Justice | Residential Treatment Facility, Emotionally Disturbed Children | 2112 Chandler Ave, Columbia, SC 29210-6204 | 2013-02-07 |
| 1477820504 | Cherokee Creek Boys School | Residential Treatment Facility, Emotionally Disturbed Children | 198 Cooper Rd, Westminster, SC 29693-3309 | 2011-11-17 |
| 1124260427 | Broadstep Academy-sc, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1370 N Williamsburg County Hwy, Kingstree, SC 29556-7027 | 2009-04-01 |
| 1235325242 | New Beginnings of Charleston Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 716 W Front St, Lincolnville, SC 29485-7112 | 2007-09-24 |
| 1639399553 | Orangeburg Attention Homes, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 155 Wall St Rm 16, Orangeburg, SC 29115-5404 | 2007-04-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.