Provider Demographics
NPI:1336189620
Name:PEAK MEDICAL COLORADO NO. 3 LLC
Entity Type:Organization
Organization Name:PEAK MEDICAL COLORADO NO. 3 LLC
Other - Org Name:BEAR CREEK 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:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:150 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-2532
Mailing Address - Country:US
Mailing Address - Phone:303-697-8181
Mailing Address - Fax:
Practice Address - Street 1:150 SPRING ST
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-2532
Practice Address - Country:US
Practice Address - Phone:303-697-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEAK MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO020435314000000X
CO385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11766OtherBLUE CROSS
CO7100593OtherEVERCARE
CO83606041Medicaid
CO=========OtherSECURE HORIZONS
CO7100593OtherEVERCARE