Provider Demographics
NPI:1508533365
Name:PINNACLE COMMUNITY LIVING
Entity Type:Organization
Organization Name:PINNACLE COMMUNITY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COMFORT
Authorized Official - Middle Name:S
Authorized Official - Last Name:EKPENYONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:214-275-8898
Mailing Address - Street 1:3727 DILIDO RD STE 138
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-8665
Mailing Address - Country:US
Mailing Address - Phone:214-869-8824
Mailing Address - Fax:469-251-5553
Practice Address - Street 1:6225 FITZGERALD CT
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-3525
Practice Address - Country:US
Practice Address - Phone:972-220-8361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:370808
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities