Healthcare Provider Details

I. General information

NPI: 1154678498
Provider Name (Legal Business Name): PEAK RESOURCES OF ALAMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

779 WOODY DR
GRAHAM NC
27253-3812
US

IV. Provider business mailing address

779 WOODY DR
GRAHAM NC
27253-3812
US

V. Phone/Fax

Practice location:
  • Phone: 336-228-8394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4885
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LISA WYRICK
Title or Position: ADMINISTRATOR
Credential:
Phone: 336-228-8394