Provider Demographics
NPI:1043402233
Name:PINNACLE PROGRAMS, INC
Entity Type:Organization
Organization Name:PINNACLE PROGRAMS, INC
Other - Org Name:SOUTHWESTERN YOUTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-283-4425
Mailing Address - Street 1:401 W LUVERNE ST
Mailing Address - Street 2:PO BOX 40
Mailing Address - City:MAGNOLIA
Mailing Address - State:MN
Mailing Address - Zip Code:56158-2004
Mailing Address - Country:US
Mailing Address - Phone:507-283-4425
Mailing Address - Fax:507-283-4284
Practice Address - Street 1:401 W LUVERNE ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MN
Practice Address - Zip Code:56158-2004
Practice Address - Country:US
Practice Address - Phone:507-283-4425
Practice Address - Fax:507-283-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1036948-1-CRF322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5160420Medicaid