Provider Demographics
NPI:1669921532
Name:HEAVENS PEAK BEHAVIORAL HEALTH SERVICES, INS
Entity type:Organization
Organization Name:HEAVENS PEAK BEHAVIORAL HEALTH SERVICES, INS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-645-3384
Mailing Address - Street 1:64 SAFE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435
Mailing Address - Country:US
Mailing Address - Phone:307-645-3384
Mailing Address - Fax:866-320-1673
Practice Address - Street 1:64 SAFE HAVEN RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435
Practice Address - Country:US
Practice Address - Phone:307-645-3384
Practice Address - Fax:866-320-1673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health