Provider Demographics
NPI:1245974062
Name:PEAK HEALTH LLC
Entity type:Organization
Organization Name:PEAK HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-386-0186
Mailing Address - Street 1:215 WESTWARD DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5259
Mailing Address - Country:US
Mailing Address - Phone:305-887-4494
Mailing Address - Fax:
Practice Address - Street 1:215 WESTWARD DR
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5259
Practice Address - Country:US
Practice Address - Phone:305-887-4494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116042700Medicaid