Healthcare Provider Details

I. General information

NPI: 1144698812
Provider Name (Legal Business Name): PINNACLE ENRICHMENT HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE STE E101
CLINTON MD
20735-1628
US

IV. Provider business mailing address

7700 OLD BRANCH AVE STE E101
CLINTON MD
20735-1628
US

V. Phone/Fax

Practice location:
  • Phone: 301-877-1400
  • Fax: 301-576-7968
Mailing address:
  • Phone: 301-877-1400
  • Fax: 301-576-7968

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 Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MYRON V JOHNSON
Title or Position: OWNER
Credential:
Phone: 901-270-8002