Active NPI
Pinnacle Homes Dda LLC
- Mental Illness Community Based Residential Treatment Facility
- Pinnacle, NC
National Provider Identifier
1669533279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Community Based Residential Treatment Facility
- Legal business name
- PINNACLE HOMES DDA LLC
- Practice address
- 1169 Perch Rd
Pinnacle, NC 27043-8312 - Phone
- (336) 368-2636
- Fax
- (336) 368-2639
- NPI assigned
- Dec 13, 2006
- Last updated
- Jan 22, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Ellis Reid Forest
- Title
- Administrator-Owner
- Phone
- (336) 368-2778
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | Primary |
Addresses
Primary practice location
1169 Perch Rd
Pinnacle, NC 27043-8312
Mailing address
1169 Perch Rd
PO Box 70
Pinnacle, NC 27043-8312
Phone (336) 368-2636
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7804284 | Medicaid | NC |
National Provider Directory
National Provider Directory- Tax ID family
- Pinnacle Homes Dda LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mental Illness Community Based Residential Treatment Facility
- Pinnacle, NC
- NPI 1740330026
-
- Mental Illness Community Based Residential Treatment Facility
- Pinnacle, NC
- NPI 1205913019
Locations
1169 Perch Rd
Pinnacle, NC 27043
Phone (336) 368-2778
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1358812800000",
"number": "1669533279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1169 PERCH RD",
"address_2": "PO BOX 70",
"city": "PINNACLE",
"state": "NC",
"postal_code": "270438312",
"telephone_number": "336-368-2636",
"fax_number": "336-368-2639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1169 PERCH RD",
"city": "PINNACLE",
"state": "NC",
"postal_code": "270438312",
"telephone_number": "336-368-2636",
"fax_number": "336-368-2639"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PINNACLE HOMES DDA LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-13",
"last_updated": "2013-01-22",
"status": "A",
"authorized_official_last_name": "FOREST",
"authorized_official_first_name": "ELLIS",
"authorized_official_middle_name": "REID",
"authorized_official_title_or_position": "ADMINISTRATOR-OWNER",
"authorized_official_telephone_number": "336-368-2778",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7804284",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pinnacle, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.