Healthcare Provider Details

I. General information

NPI: 1184813107
Provider Name (Legal Business Name): PEAK COMMUNITY SUPPORTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S 1ST ST STE 101
LOUISVILLE KY
40202-1416
US

IV. Provider business mailing address

410 S 1ST ST STE 101
LOUISVILLE KY
40202-1416
US

V. Phone/Fax

Practice location:
  • Phone: 502-363-1700
  • Fax: 502-363-1705
Mailing address:
  • Phone: 502-363-1700
  • Fax: 502-363-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateKY

VIII. Authorized Official

Name: MS. ANGELWAND R POINTER
Title or Position: OFFICE MANAGER
Credential: BA
Phone: 502-363-1700