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NPI Code Detail

MEDICARE: PINNACLE TREATMENT CENTERS OH-IX, LLC

MEDICARE: PINNACLE TREATMENT CENTERS OH-IX, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2800XMethadone Clinic

General Provider Information

NPI Number : 1275096083
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINNACLE TREATMENT CENTERS OH-IX, LLC
Provider Business Mailing Address
First Line : 1317 ROUTE 73
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-2202
Country : US
Telephone Number : 856-439-6111
Fax Number :
Provider Business Practice Location Address
First Line : 115 S REYNOLDS RD STE C
Second Line :
City : TOLEDO
State : OH
Zip : 43615-6958
Country : US
Telephone Number : 419-725-6631
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR CONTRACT MGMT
Name : ROBYN TANIS
Credential :
Telephone Number : 856-533-8762
Provider Enumeration Date : 04/09/2019
Last Update Date : 12/23/2019

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