Basic Information
| Provider Information | |||||||||
| NPI: | 1508348038 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BHC PINNACLE POINTE HEALTHCARE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | PINNACLE POINTE OUTPATIENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1249 LAKESIDE RD | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719017354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012622544 | ||||||||
| FaxNumber: | 5012622544 | ||||||||
| Practice Location | |||||||||
| Address1: | 139C E JACKSON AVE | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716554933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702248109 | ||||||||
| FaxNumber: | 8702248110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2018 | ||||||||
| LastUpdateDate: | 10/03/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BARNES | ||||||||
| AuthorizedOfficialFirstName: | AMBER | ||||||||
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| AuthorizedOfficialTitleorPosition: | UR MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5012622766 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.