Provider Demographics
NPI:1346481132
Name:PEAK WELLNESS CENTER
Entity Type:Organization
Organization Name:PEAK WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MATHIAS
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-632-9362
Mailing Address - Street 1:1954 W MARIPOSA PKWY
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-3102
Mailing Address - Country:US
Mailing Address - Phone:307-322-3190
Mailing Address - Fax:
Practice Address - Street 1:1954 W MARIPOSA PKWY
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3102
Practice Address - Country:US
Practice Address - Phone:307-322-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106079105Medicaid