1659732527 NPI number — PINNACLE COMMUNITY SERVICES, LTD

Table of content: (NPI 1659732527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659732527 NPI number — PINNACLE COMMUNITY SERVICES, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE COMMUNITY SERVICES, LTD
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:
Provider Other Organization Name Type Code:
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:
1659732527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
845 PROTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-4203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-340-7155
Provider Business Mailing Address Fax Number:
210-340-4832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3435 W CHEYENNE AVE
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89032-8206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-798-2700
Provider Business Practice Location Address Fax Number:
702-798-9010
Provider Enumeration Date:
03/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MANNING-THOMPSON
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
210-340-7155

Provider Taxonomy Codes

  • Taxonomy code: 385H00000X , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9005037864 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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