Organization
PINNACLE TREATMENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN ROSS (CEO)
(917) 903-7445
Entity
Organization
Contact information
Practice address
445 MILLER VALLEY RD, PRESCOTT, AZ 86301-2925
(928) 277-1863
Mailing address
PO BOX 4333, PRESCOTT, AZ 86302-4333
(928) 227-1742
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC9631
STATE LICENSE
AZ
Enumeration date
09/03/2016
Last updated
01/13/2023
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