Provider Demographics
NPI:1245778950
Name:BLUE PEAKS DEVELOPMENTAL SERVICES INC.
Entity Type:Organization
Organization Name:BLUE PEAKS DEVELOPMENTAL SERVICES INC.
Other - Org Name:STEPHENS HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KINSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-589-5135
Mailing Address - Street 1:703 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2524
Mailing Address - Country:US
Mailing Address - Phone:719-589-5135
Mailing Address - Fax:719-589-0680
Practice Address - Street 1:8586 COOL SUNSHINE CIR
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-9623
Practice Address - Country:US
Practice Address - Phone:719-589-5135
Practice Address - Fax:719-589-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO05L195320600000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26685043Medicaid