Provider Demographics
NPI:1730417783
Name:HIDDEN PINES, INC.
Entity type:Organization
Organization Name:HIDDEN PINES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-487-9067
Mailing Address - Street 1:8429 IDYLLVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-3617
Mailing Address - Country:US
Mailing Address - Phone:608-487-9067
Mailing Address - Fax:608-487-9067
Practice Address - Street 1:N5085 18TH RD
Practice Address - Street 2:
Practice Address - City:WILD ROSE
Practice Address - State:WI
Practice Address - Zip Code:54984-5915
Practice Address - Country:US
Practice Address - Phone:920-622-3711
Practice Address - Fax:920-622-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness