Healthcare Provider Details

I. General information

NPI: 1760929202
Provider Name (Legal Business Name): BLUE PEAKS DEVELOPMENTAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 DAVIS ST
MONTE VISTA CO
81144-1204
US

IV. Provider business mailing address

703 4TH ST
ALAMOSA CO
81101-2524
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-5135
  • Fax: 719-589-0680
Mailing address:
  • Phone: 719-589-5135
  • Fax: 719-589-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number051008
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number051008
License Number StateCO

VIII. Authorized Official

Name: ANITA M KINSEY
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 719-589-5135