Organization
PINNACLE HOMES DDA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELLIS REID FOREST (ADMINISTRATOR-OWNER)
(336) 368-2778
Entity
Organization
Contact information
Practice address
1169 PERCH RD, PINNACLE, NC 27043-8312
(336) 368-2636
(336) 368-2639
Mailing address
1169 PERCH RD, PO BOX 70, PINNACLE, NC 27043-8312
(336) 368-2636
(336) 368-2639
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804284
—
NC
Enumeration date
12/13/2006
Last updated
01/22/2013
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