Healthcare Provider Details

I. General information

NPI: 1780201772
Provider Name (Legal Business Name): PINNACLE PEAK RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8070 E MORGAN TRL STE 125
SCOTTSDALE AZ
85258-1228
US

IV. Provider business mailing address

8070 E MORGAN TRL STE 200
SCOTTSDALE AZ
85258-1229
US

V. Phone/Fax

Practice location:
  • Phone: 480-430-6744
  • Fax:
Mailing address:
  • Phone: 480-430-6744
  • 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: FOUNDER
Credential:
Phone: 480-750-1200