MEDICARE: PINNACLE GROUP OF HUDSON VALLEY IV 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	291U00000X	Clinical Medical Laboratory
2	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1154973063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE GROUP OF HUDSON VALLEY IV LLC

Provider Business Mailing Address
First Line	:	3 VILLA LN
Second Line	:
City	:	MONSEY
State	:	NY
Zip	:	10952-1021
Country	:	US
Telephone Number	:	845-596-6633
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 ANTHOINE ST
Second Line	:
City	:	S PORTLAND
State	:	ME
Zip	:	04106-4403
Country	:	US
Telephone Number	:	207-799-8561
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ISRAEL NACHFOLGER
Credential	:	RN, NREMTP
Telephone Number	:	845-596-6633

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	10/31/2022

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