Provider Demographics
NPI:1942635339
Name:PINNACLE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:PINNACLE HEALTHCARE SERVICES LLC
Other - Org Name:PINNACLE HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AVRIL
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:JACKSON-BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:781-510-9793
Mailing Address - Street 1:140 WOOD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2512
Mailing Address - Country:US
Mailing Address - Phone:781-884-1539
Mailing Address - Fax:781-228-6185
Practice Address - Street 1:140 WOOD RD
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-884-1539
Practice Address - Fax:781-228-6185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184437363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS100104802OtherMEDICARE PTAN