Provider Demographics
NPI:1689600082
Name:PINNACLE HOME CARE OF PINELLAS, INC.
Entity Type:Organization
Organization Name:PINNACLE HOME CARE OF PINELLAS, INC.
Other - Org Name:PINNACLE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:727-534-7526
Mailing Address - Street 1:4023 TAMPA RD STE 2200
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3212
Mailing Address - Country:US
Mailing Address - Phone:727-534-7526
Mailing Address - Fax:352-666-2759
Practice Address - Street 1:1787 S PINELLAS AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1929
Practice Address - Country:US
Practice Address - Phone:727-938-7505
Practice Address - Fax:727-938-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992336251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108290Medicare ID - Type UnspecifiedHHA PROVIDER NUMBER