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NPI Code Detail

MEDICARE: PINNACLE TREATMENT CENTERS OH-XII, LLC

MEDICARE: PINNACLE TREATMENT CENTERS OH-XII, 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
1261QR0800XRecovery Care Clinic/Center
2261QM2800XMethadone Clinic

General Provider Information

NPI Number : 1790301869
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINNACLE TREATMENT CENTERS OH-XII, LLC
Provider Business Mailing Address
First Line : 1317 ROUTE 73 STE 200
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 : 1036 CLEVELAND RD
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-4034
Country : US
Telephone Number : 419-504-0068
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR OF CONTRACT MGMT
Name : ROBYN TANIS
Credential :
Telephone Number : 856-533-8762
Provider Enumeration Date : 06/24/2020
Last Update Date : 06/24/2020

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