Provider Demographics
NPI:1437204559
Name:PINNACLE HOME HEALTH CARE AGENCY INC.
Entity type:Organization
Organization Name:PINNACLE HOME HEALTH CARE AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:BLUE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:937-426-1888
Mailing Address - Street 1:3045 RODENBECK DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2670
Mailing Address - Country:US
Mailing Address - Phone:937-426-1888
Mailing Address - Fax:937-426-1880
Practice Address - Street 1:3045 RODENBECK DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2670
Practice Address - Country:US
Practice Address - Phone:937-426-1888
Practice Address - Fax:937-426-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH368038251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36-8038Medicare PIN
OH368038Medicare ID - Type Unspecified