Provider Demographics
NPI:1720719743
Name:PEAK RESIDENTIAL SUPPORTS, L.L.C.
Entity Type:Organization
Organization Name:PEAK RESIDENTIAL SUPPORTS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOTSIRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-908-0623
Mailing Address - Street 1:4010 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4112
Mailing Address - Country:US
Mailing Address - Phone:810-908-0623
Mailing Address - Fax:
Practice Address - Street 1:4010 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4112
Practice Address - Country:US
Practice Address - Phone:810-908-0623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities