Provider Demographics
NPI:1316308497
Name:PINNACLE SENIOR CARE OF INDIANA, LLC
Entity type:Organization
Organization Name:PINNACLE SENIOR CARE OF INDIANA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT HOME HEALTH & HOSPICE
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:VASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-781-1535
Mailing Address - Street 1:500 KIRTS BLVD
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4134
Mailing Address - Country:US
Mailing Address - Phone:248-824-6584
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:9100 PURDUE RD
Practice Address - Street 2:STE. 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1172
Practice Address - Country:US
Practice Address - Phone:317-982-6024
Practice Address - Fax:844-410-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN16-013954-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN013954OtherSTATE HHA LICENSE