MEDICARE: PINNACLE OPPORTUNITIES INC

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	43257	IL

General Provider Information

NPI Number	:	1972775807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE OPPORTUNITIES INC

Provider Business Mailing Address
First Line	:	285 SOUTH FARNHAM STREET
Second Line	:
City	:	GALESBURG
State	:	IL
Zip	:	61401-5323
Country	:	US
Telephone Number	:	309-343-1550
Fax Number	:	309-343-6318

Provider Business Practice Location Address
First Line	:	260 S CHICAGO AVENUE
Second Line	:
City	:	KANKAKEE
State	:	IL
Zip	:	60901-4005
Country	:	US
Telephone Number	:	815-936-0905
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED AGENT
Name	:	MR. RONALD J WILSON
Credential	:
Telephone Number	:	309-343-1550

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	04/20/2008

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