Provider Demographics
NPI:1760439830
Name:PINNACLE CENTER FOR MENTAL HEALTH & HUMAN RELATIONS LLC
Entity Type:Organization
Organization Name:PINNACLE CENTER FOR MENTAL HEALTH & HUMAN RELATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-705-7593
Mailing Address - Street 1:603 POST OFFICE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:603 POST OFFICE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1914
Practice Address - Country:US
Practice Address - Phone:301-705-7593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD194401100Medicaid
MD194401100Medicaid