Organization
PEAK MEDICAL IDAHO OPERATIONS LLC
Active
Parent organization
PEAK MEDICAL LLC
Other names
Rexburg Care and Rehabilitation Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEAK MEDICAL LLC
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
660 S 2ND W, REXBURG, ID 83440-2300
(208) 356-0220
Mailing address
660 S 2ND W, REXBURG, ID 83440-2300
(208) 356-0220
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
52
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010013225
BLUE SHIELD OF IDAHO
ID
01
—
01297
BLUE CROSS
ID
05
—
805165000
—
ID
Enumeration date
05/20/2006
Last updated
03/29/2016
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