Healthcare Provider Details

I. General information

NPI: 1508235904
Provider Name (Legal Business Name): PINNACLE TREATMENT CENTERS KY-I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 CINCINNATI ROAD
GEORGETOWN KY
40324
US

IV. Provider business mailing address

1317 ROUTE 73 STE 200
MOUNT LAUREL NJ
08054-2202
US

V. Phone/Fax

Practice location:
  • Phone: 502-570-9313
  • Fax:
Mailing address:
  • Phone: 856-439-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number800188
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number800188
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number800188
License Number StateKY

VIII. Authorized Official

Name: ROBYN TANIS
Title or Position: EXECUTIVE DIRECTOR OF CONTRACT MGMT
Credential:
Phone: 856-533-8762