Provider Demographics
NPI:1033520465
Name:PINNACLE LAND SERVICES CORPORATION
Entity Type:Organization
Organization Name:PINNACLE LAND SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:ZAYNE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-429-9191
Mailing Address - Street 1:8002 CHERRY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-9007
Mailing Address - Country:US
Mailing Address - Phone:352-429-9191
Mailing Address - Fax:352-429-2704
Practice Address - Street 1:8002 CHERRY LAKE RD
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-9007
Practice Address - Country:US
Practice Address - Phone:352-429-9191
Practice Address - Fax:352-429-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLGCG1506681171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001065900Medicaid