Healthcare Provider Details

I. General information

NPI: 1336189620
Provider Name (Legal Business Name): PEAK MEDICAL COLORADO NO. 3 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SPRING ST
MORRISON CO
80465-2532
US

IV. Provider business mailing address

150 SPRING ST
MORRISON CO
80465-2532
US

V. Phone/Fax

Practice location:
  • Phone: 303-697-8181
  • Fax:
Mailing address:
  • Phone: 303-697-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020435
License Number StateCO

VIII. Authorized Official

Name: MICHAEL T. BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4752