MEDICARE: PEAK PINNACLE HOMECARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1508503095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK PINNACLE HOMECARE SERVICES LLC

Provider Business Mailing Address
First Line	:	53 WILLOWBROOK LN
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-6217
Country	:	US
Telephone Number	:	724-914-0140
Fax Number	:

Provider Business Practice Location Address
First Line	:	893 HENDERSON AVE
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-1369
Country	:	US
Telephone Number	:	724-506-8976
Fax Number	:	724-277-6229

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL KETZELL
Credential	:
Telephone Number	:	724-914-0140

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/15/2023

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