Healthcare Provider Details

I. General information

NPI: 1811598253
Provider Name (Legal Business Name): PINNACLE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45369 W HORSE MESA RD
MARICOPA AZ
85139-9128
US

IV. Provider business mailing address

20987 N JOHN WAYNE PKWY # B104-289
MARICOPA AZ
85139-2926
US

V. Phone/Fax

Practice location:
  • Phone: 480-388-4906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN O'NEAL
Title or Position: CEO
Credential:
Phone: 480-388-4906