Provider Demographics
NPI:1952666588
Name:PINNACLE HOSPICE, LLC
Entity Type:Organization
Organization Name:PINNACLE HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-207-0390
Mailing Address - Street 1:10532 AUTO MALL PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-3708
Mailing Address - Country:US
Mailing Address - Phone:228-207-0390
Mailing Address - Fax:228-207-0392
Practice Address - Street 1:10532 AUTO MALL PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-3708
Practice Address - Country:US
Practice Address - Phone:228-207-0390
Practice Address - Fax:228-207-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS214251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS251679Medicare Oscar/Certification