Healthcare Provider Details

I. General information

NPI: 1669921532
Provider Name (Legal Business Name): HEAVENS PEAK BEHAVIORAL HEALTH SERVICES, INS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 SAFE HAVEN RD
POWELL WY
82435
US

IV. Provider business mailing address

64 SAFE HAVEN RD
POWELL WY
82435
US

V. Phone/Fax

Practice location:
  • Phone: 307-645-3384
  • Fax: 866-320-1673
Mailing address:
  • Phone: 307-645-3384
  • Fax: 866-320-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA C WOODWARD
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 307-645-3384