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General NPI Number Information
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NPI Number | 1750649927
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Entity Type | Organization
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Legal Business Name | PINNACLE SOBER LIVING LLC
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 1561 NE 44TH ST
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City | POMPANO BEACH
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State | FL
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Zip | 33064-5868
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Country | US
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Telephone | 754-779-4574
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Fax |
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Provider Business Mailing Address
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Address Line | 1561 NE 44TH ST
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City | POMPANO BEACH
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State | FL
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Zip | 33064-5868
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Country | US
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Telephone | 784-779-4574
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Fax | 954-532-4048
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Authorized Official
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Title or Position | CEO
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Name | MR. RICHARD S MARTINS
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Credential |
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Telephone | 754-779-4574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 10D2035945
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License Number State | FL
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