MEDICARE: PINNACLE FAMILY CARE HOME 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1962340034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE FAMILY CARE HOME LLC

Provider Business Mailing Address
First Line	:	1444 HERON POND ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-9709
Country	:	US
Telephone Number	:	919-327-7305
Fax Number	:

Provider Business Practice Location Address
First Line	:	1444 HERON POND ST # T
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-9709
Country	:	US
Telephone Number	:	919-327-7305
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NYIMA KEITA
Credential	:
Telephone Number	:	919-327-7305

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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