Peak Medical Peachtree, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

2004ALII7538 Issued in UT

Legal business name

PEAK MEDICAL PEACHTREE, INC.

Doing business as

Country Lane Assisted Living

Practice address

985 S 800 W
Brigham City, UT 84302-3042

Phone

(435) 723-1394

Fax

(435) 723-1416

NPI assigned

May 24, 2006

Last updated

Sep 28, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

SUNBRIDGE HEALTHCARE CORPORATIONAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William A. Mathies

Title

President Director

Phone

(505) 821-3355

Specialties & licenses 2

Addresses

Other names 1

• Country Lane Assisted Living Doing business as

Part of

Terrace Hghts Nursing H

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254096000000",
    "number": "1144275587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUN AVE NE",
            "address_2": "COMPLIANCE DEPARTMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094373",
            "telephone_number": "505-468-5604",
            "fax_number": "505-468-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "985 S 800 W",
            "city": "BRIGHAM CITY",
            "state": "UT",
            "postal_code": "843023042",
            "telephone_number": "435-723-1394",
            "fax_number": "435-723-1416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK MEDICAL PEACHTREE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNBRIDGE HEALTHCARE CORPORATION",
        "enumeration_date": "2006-05-24",
        "last_updated": "2009-09-28",
        "status": "A",
        "authorized_official_last_name": "MATHIES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT DIRECTOR",
        "authorized_official_telephone_number": "505-821-3355"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "UT",
            "license": "2004ALI47536",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "UT",
            "license": "2004ALII7538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Lane Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jose Roman Pantoja
• Lydia Park
• Sydney Parker
• Riley Parkinson
• Kayla Payne
• Peak Medical Utah No. 2, Inc. (Brigham City Nursing & Rehab)
• Adam T Peck
• Tina Peck, LCSW
• Verlicia Annette Perez
• Perry Family Medicine LLC

• Assisted Living Facility in Brigham City, UT
• Providers in Brigham City, UT by specialty
• Assisted Living Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.