MEDICARE: PINNACLE POINT SUPPORTIVE SERVICES, 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
1	251S00000X	Community/Behavioral Health Agency		NC

General Provider Information

NPI Number	:	1053617456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE POINT SUPPORTIVE SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 253
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28106-0253
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4037 E INDEPENDENCE BLVD BLDG SUITE603
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-3260
Country	:	US
Telephone Number	:	704-523-5775
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS DALORIA TEAGUE
Credential	:
Telephone Number	:	704-523-5775

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	12/05/2024

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