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General NPI Number Information
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NPI Number | 1336189620
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Entity Type | Organization
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Legal Business Name | PEAK MEDICAL COLORADO NO. 3 LLC
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 150 SPRING ST
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City | MORRISON
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State | CO
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Zip | 80465-2532
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Country | US
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Telephone | 303-697-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 150 SPRING ST
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City | MORRISON
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State | CO
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Zip | 80465-2532
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Country | US
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Telephone | 303-697-8181
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Fax |
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | MICHAEL T. BERG
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Credential |
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Telephone | 505-468-4752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 020435
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License Number State | CO
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