Provider Demographics
NPI:1063986875
Name:PINNACLE IN HOME CARE, LLC
Entity type:Organization
Organization Name:PINNACLE IN HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-366-3218
Mailing Address - Street 1:213 W MONROE AVE STE L
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9451
Mailing Address - Country:US
Mailing Address - Phone:479-595-8663
Mailing Address - Fax:479-802-3156
Practice Address - Street 1:213 W MONROE AVE STE L
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9451
Practice Address - Country:US
Practice Address - Phone:479-595-8663
Practice Address - Fax:479-802-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR230008732Medicaid