PINNACLE OPPORTUNITIES INC NPI 1659543007

NPI Information

NPI: 1659543007
Provider Name: PINNACLE OPPORTUNITIES INC

Doing Business As: CHAMNESS SQUARE

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization

Address:
340 HERITAGE DRIVE
BOURBONNAIS, IL
ZIP 60914
Phone: (815) 932-2745
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PINNACLE OPPORTUNITIES INC is an intermediate care facility mentally retarded in Bourbonnais, IL. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. PINNACLE OPPORTUNITIES INC NPI is 1659543007. The provider is registered as an organization entity type.
The provider Is Doing Business As Chamness Square.

The provider's business location address is:

340 HERITAGE DRIVE
BOURBONNAIS, IL
ZIP 60914-261
Phone: (815) 932-2745
Fax: (815) 936-1739

The provider's authorized official is Ronald J Wilson .
The authorized official title is Authorized Agent and has the following contact phone number (309) 343-1550.

The CLIA number assigned to this NPI record is 14D0945006 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/26/2008 and was last updated on 4/20/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		48017	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========007	MEDICAID	ILLINOIS

What is NPI?

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This page was last updated on: 5/5/2024

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