Provider Demographics
NPI:1720592751
Name:PINNACLE HOME CARE OF SW FLORIDA, LLC
Entity Type:Organization
Organization Name:PINNACLE HOME CARE OF SW FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-541-5354
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:239-541-5354
Mailing Address - Fax:
Practice Address - Street 1:5280 SUMMERLIN COMMONS WAY STE 803
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2160
Practice Address - Country:US
Practice Address - Phone:239-541-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299994118251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health