Provider Demographics
NPI:1780201772
Name:PINNACLE PEAK RECOVERY, LLC
Entity Type:Organization
Organization Name:PINNACLE PEAK RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:TISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-750-1200
Mailing Address - Street 1:8070 E MORGAN TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1229
Mailing Address - Country:US
Mailing Address - Phone:480-430-6744
Mailing Address - Fax:
Practice Address - Street 1:8070 E MORGAN TRL STE 125
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1228
Practice Address - Country:US
Practice Address - Phone:480-430-6744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE PEAK RECOVERY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility