Provider Demographics
NPI:1063026722
Name:STEVENSON PINNACLE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:STEVENSON PINNACLE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEFON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-263-5648
Mailing Address - Street 1:61 DRAKE AVE APT A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4120
Mailing Address - Country:US
Mailing Address - Phone:336-263-5648
Mailing Address - Fax:
Practice Address - Street 1:61 DRAKE AVE APT A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4120
Practice Address - Country:US
Practice Address - Phone:336-263-5648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health