Provider Demographics
NPI:1619789245
Name:PINNACLE WELLNESS HEALTHCARE SERVICES
Entity type:Organization
Organization Name:PINNACLE WELLNESS HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LATASHA
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTER NURSE
Authorized Official - Phone:904-505-7369
Mailing Address - Street 1:2344 BRADLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-5104
Mailing Address - Country:US
Mailing Address - Phone:904-505-7369
Mailing Address - Fax:
Practice Address - Street 1:2344 BRADLEY PARK DR
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-5104
Practice Address - Country:US
Practice Address - Phone:904-505-7369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health