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NPI Code Detail

MEDICARE: PINNACLE TREATMENT CENTERS OH-I, LLC

MEDICARE: PINNACLE TREATMENT CENTERS OH-I, 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
1101YA0400XAddiction (Substance Use Disorder) CounselorOH
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/CenterOH
3324500000XSubstance Abuse Rehabilitation FacilityOH

General Provider Information

NPI Number : 1649631086
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINNACLE TREATMENT CENTERS OH-I, LLC
Provider Business Mailing Address
First Line : 1317 ROUTE 73
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-2202
Country : US
Telephone Number : 856-439-6111
Fax Number : 502-867-7978
Provider Business Practice Location Address
First Line : 7400 HUNTINGTON PARK DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43235-5617
Country : US
Telephone Number : 412-255-8717
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR OF CONTRACT MGMT
Name : ROBYN TANIS
Credential :
Telephone Number : 856-533-8762
Provider Enumeration Date : 03/13/2016
Last Update Date : 08/23/2022

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