Provider Demographics
NPI:1740315514
Name:THE PEAK AT SANTA TERESA, INC.
Entity type:Organization
Organization Name:THE PEAK AT SANTA TERESA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-361-3333
Mailing Address - Street 1:PO BOX 2211
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88221-2211
Mailing Address - Country:US
Mailing Address - Phone:575-361-3333
Mailing Address - Fax:575-885-5940
Practice Address - Street 1:4202 W MCGAFFEY ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-9384
Practice Address - Country:US
Practice Address - Phone:575-623-6749
Practice Address - Fax:575-623-1322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PEAK AT SANTA TERESA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-22
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251S00000X
NMNO NUMBER253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK9392Medicaid
NM219Medicaid
NM218Medicaid
NMM1696Medicaid