MEDICARE: PEACH HOME HEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	52022023	OTHER	GA	BC BS
3	337178	OTHER	GA	WELLCARE HEALTH PLANS
4	139844	OTHER	GA	PEACHSTATE HEALTH PLANS

General Provider Information

NPI Number	:	1114902095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACH HOME HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	555 E NORTH LN STE 5075
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	585 CARL VINSON PKWY STE 1000
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-3653
Country	:	US
Telephone Number	:	478-971-4411
Fax Number	:	478-971-1631

Authorized Official
Title or Position	:	CCO
Name	:	WENDY RUSSALESI
Credential	:
Telephone Number	:	484-246-9499

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	12/04/2025

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Directions to “PEACH HOME HEALTH CARE, INC. ” Practice Location

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