Provider Demographics
NPI:1750649927
Name:PINNACLE SOBER LIVING LLC
Entity Type:Organization
Organization Name:PINNACLE SOBER LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-779-4574
Mailing Address - Street 1:1561 NE 44TH ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-5868
Mailing Address - Country:US
Mailing Address - Phone:784-779-4574
Mailing Address - Fax:954-532-4048
Practice Address - Street 1:1561 NE 44TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5868
Practice Address - Country:US
Practice Address - Phone:754-779-4574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2035945291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19D2935845OtherCLIA WAIVER