Healthcare Provider Details

I. General information

NPI: 1104298397
Provider Name (Legal Business Name): PINNACLE HEALTHCARE OF CNY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 E GENESEE ST SUITE 204
SYRACUSE NY
13202-2197
US

IV. Provider business mailing address

430 E GENESEE ST SUITE 204
SYRACUSE NY
13202-2197
US

V. Phone/Fax

Practice location:
  • Phone: 315-263-0072
  • Fax:
Mailing address:
  • Phone: 315-263-0072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK E SWAN
Title or Position: PRESIDENT
Credential:
Phone: 315-263-0072