Provider Demographics
NPI:1356904106
Name:PINNACLE HEALTH SERVICES
Entity type:Organization
Organization Name:PINNACLE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:KA
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-917-4346
Mailing Address - Street 1:879 CARRIAGE RUN CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-2414
Mailing Address - Country:US
Mailing Address - Phone:404-917-4346
Mailing Address - Fax:
Practice Address - Street 1:228 S MILITARY RD STE 204
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4819
Practice Address - Country:US
Practice Address - Phone:404-917-4346
Practice Address - Fax:866-493-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100076774Medicaid