Healthcare Provider Details

I. General information

NPI: 1902316664
Provider Name (Legal Business Name): PEAK SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16898 E CRESTLINE PL
CENTENNIAL CO
80015-4007
US

IV. Provider business mailing address

16898 E CRESTLINE PL
CENTENNIAL CO
80015-4007
US

V. Phone/Fax

Practice location:
  • Phone: 720-608-0264
  • Fax:
Mailing address:
  • Phone: 720-608-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: JONA R. O'CONNOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 720-608-0264