Healthcare Provider Details

I. General information

NPI: 1215899190
Provider Name (Legal Business Name): PINNACLE CMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10161 PARK RUN DR STE 150
LAS VEGAS NV
89145-8872
US

IV. Provider business mailing address

10161 PARK RUN DR STE 150
LAS VEGAS NV
89145-8872
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-8119
  • Fax:
Mailing address:
  • Phone: 702-483-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDRE HAYNES
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 702-483-8119