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NPI Code Detail

MEDICARE: PINNACLE TREATMENT CENTERS OH-VI, LLC

MEDICARE: PINNACLE TREATMENT CENTERS OH-VI, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2800XMethadone Clinic

General Provider Information

NPI Number : 1043726797
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINNACLE TREATMENT CENTERS OH-VI, LLC
Provider Business Mailing Address
First Line : 1317 ROUTE 73
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-2202
Country : US
Telephone Number : 856-533-8762
Fax Number : 856-780-5153
Provider Business Practice Location Address
First Line : 5122 GLENCROSSING WAY
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-3361
Country : US
Telephone Number : 513-827-9044
Fax Number : 513-827-1332
Authorized Official
Title or Position : EXECUTIVE DIRECTOR CONTRACT MGMT
Name : ROBYN TANIS
Credential :
Telephone Number : 856-533-8762
Provider Enumeration Date : 12/18/2017
Last Update Date : 12/18/2017

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