Provider Demographics
NPI:1609430446
Name:PEAK MOMENTS INC.
Entity Type:Organization
Organization Name:PEAK MOMENTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-944-9650
Mailing Address - Street 1:800 W MAIN ST STE 1460
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5983
Mailing Address - Country:US
Mailing Address - Phone:208-944-9650
Mailing Address - Fax:208-960-7108
Practice Address - Street 1:800 W MAIN ST STE 1460
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5983
Practice Address - Country:US
Practice Address - Phone:208-944-9650
Practice Address - Fax:208-960-7108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care