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NPI Code Detail

MEDICARE: PEAK MEDICAL COLORADO NO. 3 LLC

MEDICARE: PEAK MEDICAL COLORADO NO. 3 LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility020435CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111766OTHERCOBLUE CROSS
27100593OTHERCOEVERCARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336189620
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEAK MEDICAL COLORADO NO. 3 LLC
Provider Business Mailing Address
First Line : 150 SPRING ST
Second Line :
City : MORRISON
State : CO
Zip : 80465-2532
Country : US
Telephone Number : 303-697-8181
Fax Number :
Provider Business Practice Location Address
First Line : 150 SPRING ST
Second Line :
City : MORRISON
State : CO
Zip : 80465-2532
Country : US
Telephone Number : 303-697-8181
Fax Number :
Authorized Official
Title or Position : ASSISTANT SECRETARY
Name : MICHAEL T. BERG
Credential :
Telephone Number : 505-468-4752
Provider Enumeration Date : 06/07/2006
Last Update Date : 07/06/2021

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