Provider Demographics
NPI:1457897647
Name:PINNACLETREATMENT CENTERS IN-1, LLC
Entity Type:Organization
Organization Name:PINNACLETREATMENT CENTERS IN-1, LLC
Other - Org Name:RECOVERY WORKS CAMBRIDGE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF CONTRACT MGMT
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-533-8762
Mailing Address - Street 1:1317 ROUTE 73 STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2202
Mailing Address - Country:US
Mailing Address - Phone:856-439-6111
Mailing Address - Fax:
Practice Address - Street 1:2060 NORTH STATE RD 1
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE CITY
Practice Address - State:IN
Practice Address - Zip Code:47327
Practice Address - Country:US
Practice Address - Phone:765-478-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE TREATMENT CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-11
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QR0405X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder