Provider Demographics
NPI:1154569689
Name:PINNACLE HEALTHCARE MANAGEMENT, INC.
Entity type:Organization
Organization Name:PINNACLE HEALTHCARE MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-746-1020
Mailing Address - Street 1:1077 GATEWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1114
Mailing Address - Country:US
Mailing Address - Phone:541-746-1020
Mailing Address - Fax:541-746-1021
Practice Address - Street 1:1077 GATEWAY LOOP
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1114
Practice Address - Country:US
Practice Address - Phone:541-746-1020
Practice Address - Fax:541-746-1021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-21
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, PediatricGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR164329Medicare Oscar/Certification