Provider Demographics
NPI:1801213657
Name:PEAK MEDICAL COLORADO NO. 2, INC.
Entity Type:Organization
Organization Name:PEAK MEDICAL COLORADO NO. 2, INC.
Other - Org Name:PIKES PEAK CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-444-6350
Mailing Address - Street 1:2719 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1145
Mailing Address - Country:US
Mailing Address - Phone:719-636-1676
Mailing Address - Fax:
Practice Address - Street 1:2719 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1145
Practice Address - Country:US
Practice Address - Phone:719-636-1676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEAK MEDICAL OF COLORADO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-18
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO020522314000000X
CO385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care