Healthcare Provider Details

I. General information

NPI: 1922463496
Provider Name (Legal Business Name): PINNACLE PEAK RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8070 E MORGAN TRL SUITE 200
SCOTTSDALE AZ
85258-1227
US

IV. Provider business mailing address

8070 E MORGAN TRL SUITE 200
SCOTTSDALE AZ
85258-1227
US

V. Phone/Fax

Practice location:
  • Phone: 954-746-8232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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