Provider Demographics
NPI:1982933321
Name:PINNACLE HOME CARE OF THE VILLAGES INC
Entity Type:Organization
Organization Name:PINNACLE HOME CARE OF THE VILLAGES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-814-6000
Mailing Address - Street 1:4023 TAMPA RD STE 2200
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3212
Mailing Address - Country:US
Mailing Address - Phone:727-534-7526
Mailing Address - Fax:727-845-5015
Practice Address - Street 1:8483 SE 165TH MULBERRY LN STE 200
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5848
Practice Address - Country:US
Practice Address - Phone:352-314-9500
Practice Address - Fax:352-314-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109702Medicare UPIN