Healthcare Provider Details

I. General information

NPI: 1508683020
Provider Name (Legal Business Name): BLUE PEAKS DEVELOPMENTAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 4TH ST
ALAMOSA CO
81101-2524
US

IV. Provider business mailing address

703 4TH ST
ALAMOSA CO
81101-2524
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-5135
  • Fax:
Mailing address:
  • Phone: 719-589-5135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BROCK J. GALLEGOS
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 719-589-5135