1760929202 NPI number — BLUE PEAKS DEVELOPMENTAL SERVICES INC.

Table of content: (NPI 1760929202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760929202 NPI number — BLUE PEAKS DEVELOPMENTAL SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE PEAKS DEVELOPMENTAL SERVICES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760929202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMOSA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81101-2524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-589-5135
Provider Business Mailing Address Fax Number:
719-589-0680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 DAVIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTE VISTA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81144-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-589-5135
Provider Business Practice Location Address Fax Number:
719-589-0680
Provider Enumeration Date:
01/23/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KINSEY
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
719-589-5135

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  051008 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: 051008 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09140872 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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