Provider Demographics
NPI:1649542366
Name:BHC PINNACLE POINTE HOSPITAL, INC.
Entity type:Organization
Organization Name:BHC PINNACLE POINTE HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-223-3322
Mailing Address - Street 1:109 FRANKIE LN
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-2685
Mailing Address - Country:US
Mailing Address - Phone:870-247-3588
Mailing Address - Fax:870-247-2072
Practice Address - Street 1:109 FRANKIE LN
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602
Practice Address - Country:US
Practice Address - Phone:870-247-3588
Practice Address - Fax:870-247-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR190121526Medicaid