MEDICARE: PINNACLE EASYCARE 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	164W00000X	Licensed Practical Nurse

General Provider Information

NPI Number	:	1225243389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE EASYCARE LLC

Provider Business Mailing Address
First Line	:	7231 S EASTERN AVE
Second Line	:	B243
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0451
Country	:	US
Telephone Number	:	888-932-8550
Fax Number	:	702-932-8587

Provider Business Practice Location Address
First Line	:	7231 S EASTERN AVE
Second Line	:	B243
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0451
Country	:	US
Telephone Number	:	888-932-8550
Fax Number	:	702-932-8587

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MALISSA THATCHER
Credential	:
Telephone Number	:	702-932-8547

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

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