Provider Demographics
NPI:1760929202
Name:BLUE PEAKS DEVELOPMENTAL SERVICES INC.
Entity Type:Organization
Organization Name:BLUE PEAKS DEVELOPMENTAL SERVICES INC.
Other - Org Name:PRICE 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 1:304 DAVIS ST
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1204
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:2017-01-23
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO051008320900000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09140872Medicaid