Provider Demographics
NPI:1063752590
Name:PEAK MEDICAL HOME CARE INC.
Entity type:Organization
Organization Name:PEAK MEDICAL HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-398-1333
Mailing Address - Street 1:435 N MULFORD RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5189
Mailing Address - Country:US
Mailing Address - Phone:815-398-1333
Mailing Address - Fax:815-398-1361
Practice Address - Street 1:435 N MULFORD RD
Practice Address - Street 2:SUITE 7
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5189
Practice Address - Country:US
Practice Address - Phone:815-398-1333
Practice Address - Fax:815-398-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000389251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health