Provider Demographics
NPI:1841861127
Name:1ST PINNACLE, INC.
Entity type:Organization
Organization Name:1ST PINNACLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:LATREESE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-215-9065
Mailing Address - Street 1:650 WARRENVILLE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4315
Mailing Address - Country:US
Mailing Address - Phone:331-215-9065
Mailing Address - Fax:331-215-9077
Practice Address - Street 1:650 WARRENVILLE RD STE 120
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4315
Practice Address - Country:US
Practice Address - Phone:331-215-9065
Practice Address - Fax:331-215-9077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies