Provider Demographics
NPI:1851376081
Name:PINNACLE HOME HEALTH CARE 2005 LLC
Entity Type:Organization
Organization Name:PINNACLE HOME HEALTH CARE 2005 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:225-927-4290
Mailing Address - Street 1:1058 E WORTHY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4302
Mailing Address - Country:US
Mailing Address - Phone:985-651-9854
Mailing Address - Fax:985-651-9862
Practice Address - Street 1:1058 E WORTHY ST
Practice Address - Street 2:SUITE C
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4302
Practice Address - Country:US
Practice Address - Phone:985-651-9854
Practice Address - Fax:985-651-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA621251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1404888Medicaid
LA197607Medicare ID - Type Unspecified