Provider Demographics
NPI:1508683020
Name:BLUE PEAKS DEVELOPMENTAL SERVICES INC
Entity type:Organization
Organization Name:BLUE PEAKS DEVELOPMENTAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:J
Authorized Official - Last Name:GALLEGOS
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:
Practice Address - Street 1:703 4TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2524
Practice Address - Country:US
Practice Address - Phone:719-589-5135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE PEAKS DEVELOPMENTAL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency