Healthcare Provider Details

I. General information

NPI: 1346876612
Provider Name (Legal Business Name): PEAK MEDICAL COLORADO NO. 3 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL THEODORE BERG
Title or Position: VP ASST SECRETARY
Credential:
Phone: 505-468-4742