=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902961857
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINNACLE HEALTH FACILITIES XVIII LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 01/29/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 427 W MAIN ST
-----------------------------------------------------
City | GARDNER
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66030-1183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-856-8747
-----------------------------------------------------
Fax | 913-856-8339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5420 W PLANO PKWY
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-4823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-931-3800
-----------------------------------------------------
Fax | 972-767-6222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF REIMBURSEMENT
-----------------------------------------------------
Name | MRS. JAMIE LATTURE COLLIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-931-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------