1346482866 NPI number — PINNACLE BEHAVIOR HEALTH, INC

Table of content: (NPI 1346482866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346482866 NPI number — PINNACLE BEHAVIOR HEALTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE BEHAVIOR HEALTH, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELK RIVER TREATMENT PROGRAM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346482866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 GOVERNORS DRIVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-518-9998
Provider Business Mailing Address Fax Number:
256-518-9941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29495 COPPERHEAD LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKMONT
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-518-9998
Provider Business Practice Location Address Fax Number:
256-518-9941
Provider Enumeration Date:
03/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
256-518-9998

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3245S0500X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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