1720225600 NPI number — PINNACLE HEALTH CARE CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720225600 NPI number — PINNACLE HEALTH CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE HEALTH CARE CENTER, 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:
RESPIRATORY AND NURSING CARE OF DAYTON
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:
1720225600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25000 COUNTRY CLUB BLVD STE 255
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH OLMSTED
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44070-5337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-614-0160
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3421 PINNACLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORAINE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45418-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-268-3488
Provider Business Practice Location Address Fax Number:
937-267-5021
Provider Enumeration Date:
01/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-554-6619

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  6313 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2904307 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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