Provider Demographics
NPI:1164476008
Name:PEAK MEDICAL LAS CRUCES, LLC
Entity Type:Organization
Organization Name:PEAK MEDICAL LAS CRUCES, LLC
Other - Org Name:CASA DEL SOL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:2905 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4813
Mailing Address - Country:US
Mailing Address - Phone:575-522-0404
Mailing Address - Fax:
Practice Address - Street 1:2905 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4813
Practice Address - Country:US
Practice Address - Phone:575-522-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEAK MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282E00000X
NM1032314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32922OtherPRES SALUD
NM72952032Medicaid
NM00NM00M059OtherBC/BS OF NM
NM=========OtherMOLINA SALUD
NM325108Medicare Oscar/Certification