Provider Demographics
NPI:1710217070
Name:PINNACLE ASSISTED LIVING
Entity Type:Organization
Organization Name:PINNACLE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-697-5461
Mailing Address - Street 1:341 SQUIREBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2914
Mailing Address - Country:US
Mailing Address - Phone:972-697-5461
Mailing Address - Fax:888-847-8217
Practice Address - Street 1:341 SQUIREBROOK DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2914
Practice Address - Country:US
Practice Address - Phone:972-697-5461
Practice Address - Fax:888-847-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128653310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNPNP02456-0293458Medicaid
TXS72939Medicare UPIN
TXNPNP02456-0293458Medicaid