Provider Demographics
NPI:1952841819
Name:PINNACLE RECOVERY IOP
Entity type:Organization
Organization Name:PINNACLE RECOVERY IOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAQUINTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-502-7808
Mailing Address - Street 1:9102 S 300 W
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9176 S 300 W STE 6
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2669
Practice Address - Country:US
Practice Address - Phone:801-259-7533
Practice Address - Fax:833-585-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-26
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT96322409120305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization