Provider Demographics
NPI:1184813107
Name:PEAK COMMUNITY SUPPORTS, LLC
Entity type:Organization
Organization Name:PEAK COMMUNITY SUPPORTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELWAND
Authorized Official - Middle Name:R
Authorized Official - Last Name:POINTER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:502-363-1700
Mailing Address - Street 1:410 S 1ST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1416
Mailing Address - Country:US
Mailing Address - Phone:502-363-1700
Mailing Address - Fax:502-363-1705
Practice Address - Street 1:410 S 1ST ST STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1416
Practice Address - Country:US
Practice Address - Phone:502-363-1700
Practice Address - Fax:502-363-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251B00000X, 251E00000X, 251S00000X, 3245S0500X, 385HR2060X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100029880Medicaid