Provider Demographics
NPI:1659325504
Name:PEAK MEDICAL NEW MEXICO NO. 3 LLC
Entity Type:Organization
Organization Name:PEAK MEDICAL NEW MEXICO NO. 3 LLC
Other - Org Name:RIO RANCHO 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 1:4210 SABANA GRANDE AVE SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1152
Mailing Address - Country:US
Mailing Address - Phone:505-892-6603
Mailing Address - Fax:
Practice Address - Street 1:4210 SABANA GRANDE AVE SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1152
Practice Address - Country:US
Practice Address - Phone:505-892-6603
Practice Address - Fax:505-891-8774
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEAK MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1041314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48279315Medicaid
NM325033Medicare Oscar/Certification