Healthcare Provider Details

I. General information

NPI: 1225629868
Provider Name (Legal Business Name): PINNACLE PEAK RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6145 E SHEA BLVD
SCOTTSDALE AZ
85254-5423
US

IV. Provider business mailing address

8070 E MORGAN TRL
SCOTTSDALE AZ
85258-1227
US

V. Phone/Fax

Practice location:
  • Phone: 480-750-1200
  • Fax: 480-656-7758
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TYLER TISDALE
Title or Position: OWNER
Credential:
Phone: 480-750-1200