Organization
PINNACLE HOMES DDA LLC
Active
Organization
PINNACLE HOMES DDA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELLIS REID FOREST (OWNER-ADMINISTRATOR)
(336) 368-2778
Entity
Organization
Contact information
Practice address
1169 PERCH RD, PINNACLE, NC 27043-8312
(366) 368-2778
(336) 368-2779
Mailing address
1169 PERCH RD, PO BOX 70, PINNACLE, NC 27043-8312
(366) 368-2778
(336) 368-2779
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL085026
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301629
—
NC
Enumeration date
01/11/2007
Last updated
08/22/2020
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