Provider Demographics
NPI:1881317923
Name:PINNACLE SENIOR CARE OF ILLINOIS, LLC
Entity type:Organization
Organization Name:PINNACLE SENIOR CARE OF ILLINOIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:VASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-824-6000
Mailing Address - Street 1:500 KIRTS BLVD
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4134
Mailing Address - Country:US
Mailing Address - Phone:248-824-6609
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:2 TRANSAM PLAZA DR STE 260
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4811
Practice Address - Country:US
Practice Address - Phone:224-353-4490
Practice Address - Fax:630-352-3814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health