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General NPI Number Information
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NPI Number | 1851117063
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Entity Type | Organization
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Legal Business Name | PEACEFUL PEAKS LLC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 317 BROWN ST
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City | MARTINSVILLE
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State | VA
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Zip | 24112-3801
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Country | US
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Telephone | 276-806-9615
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Fax |
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Provider Business Mailing Address
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Address Line | 51 SHUMATE DR
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City | COLLINSVILLE
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State | VA
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Zip | 24078-1652
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Country | US
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Telephone | 276-806-9615
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Fax |
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Authorized Official
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Title or Position | OWNER/PROGRAM DIRECTOR
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Name | KURTASHA WALLER
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Credential | QMHPP
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Telephone | 276-806-9615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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