Provider Demographics
NPI:1841604675
Name:PEAK SPECIALTY GROUP HOSPICE
Entity type:Organization
Organization Name:PEAK SPECIALTY GROUP HOSPICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANI
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:BA ADMINISTRATOR
Authorized Official - Phone:801-557-4031
Mailing Address - Street 1:1220 E 3900 S STE 4D
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1383
Mailing Address - Country:US
Mailing Address - Phone:801-904-2340
Mailing Address - Fax:
Practice Address - Street 1:1220 E 3900 S STE 4D
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1383
Practice Address - Country:US
Practice Address - Phone:801-904-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based