Provider Demographics
NPI:1235536491
Name:PEAK RECOVERY SERVICES, LLC
Entity Type:Organization
Organization Name:PEAK RECOVERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB PISTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PISTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-877-8753
Mailing Address - Street 1:4895 WINDWARD PASSAGE DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7741
Mailing Address - Country:US
Mailing Address - Phone:561-877-8753
Mailing Address - Fax:
Practice Address - Street 1:4895 WINDWARD PASSAGE DR
Practice Address - Street 2:SUITE 6
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7741
Practice Address - Country:US
Practice Address - Phone:561-877-8753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder