Basic Information
| Provider Information | |||||||||
| NPI: | 1346481132 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEAK WELLNESS CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1954 W MARIPOSA PKWY | ||||||||
| Address2: | |||||||||
| City: | WHEATLAND | ||||||||
| State: | WY | ||||||||
| PostalCode: | 822013102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073223190 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1954 W MARIPOSA PKWY | ||||||||
| Address2: | |||||||||
| City: | WHEATLAND | ||||||||
| State: | WY | ||||||||
| PostalCode: | 822013102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073223190 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2009 | ||||||||
| LastUpdateDate: | 08/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | KAISER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | MATHIAS | ||||||||
| AuthorizedOfficialTitleorPosition: | HR DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3076329362 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 106079105 | 05 | WY | MEDICAID |