Healthcare Provider Details

I. General information

NPI: 1154569689
Provider Name (Legal Business Name): PINNACLE HEALTHCARE MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 GATEWAY LOOP
SPRINGFIELD OR
97477-1114
US

IV. Provider business mailing address

1077 GATEWAY LOOP
SPRINGFIELD OR
97477-1114
US

V. Phone/Fax

Practice location:
  • Phone: 541-746-1020
  • Fax: 541-746-1021
Mailing address:
  • Phone: 541-746-1020
  • Fax: 541-746-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK GARBER
Title or Position: CFO
Credential:
Phone: 541-746-1020