MEDICARE: PINNACLE HEALTH FACILITIES OF LOUISIANA, 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	314000000X	Skilled Nursing Facility	719	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720060544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE HEALTH FACILITIES OF LOUISIANA, LLC

Provider Business Mailing Address
First Line	:	5420 W PLANO PKWY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4823
Country	:	US
Telephone Number	:	972-931-3800
Fax Number	:	972-767-6222

Provider Business Practice Location Address
First Line	:	740 JUSTA ST
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1513
Country	:	US
Telephone Number	:	985-384-1726
Fax Number	:	985-384-4942

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	MRS. JAMIE LATTURE COLLIER
Credential	:
Telephone Number	:	972-931-3800

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	07/11/2016

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