Healthcare Provider Details

I. General information

NPI: 1386880961
Provider Name (Legal Business Name): PINNACLE HOUSE PSYCHOSOCIAL REHABILITATION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 WEST DAISY L GATSON BATES DRIVE
LITTLE ROCK AR
72202
US

IV. Provider business mailing address

4400 SHUFFIELD DR
LITTLE ROCK AR
72205
US

V. Phone/Fax

Practice location:
  • Phone: 501-371-9058
  • Fax: 501-686-9618
Mailing address:
  • Phone: 501-686-9300
  • Fax: 501-686-9618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TOM GRUNDEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 501-686-9300