Provider Demographics
NPI:1609360031
Name:PINNACLE CENTER FOR AUTISM, LLC.
Entity Type:Organization
Organization Name:PINNACLE CENTER FOR AUTISM, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OOSHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-342-8847
Mailing Address - Street 1:840 APOLLO ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4641
Mailing Address - Country:US
Mailing Address - Phone:866-342-8847
Mailing Address - Fax:866-342-8847
Practice Address - Street 1:840 APOLLO ST STE 100
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4641
Practice Address - Country:US
Practice Address - Phone:866-342-8847
Practice Address - Fax:866-342-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health