MEDICARE: MISS PEGGY GREEN

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1174826390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PEGGY GREEN

Provider Business Mailing Address
First Line	:	6400 IVORYPALMDR.
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-2435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 IVORY PALM DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-2435
Country	:	US
Telephone Number	:	704-910-5458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2010
Last Update Date	:	12/09/2010

Similar Medicare Providers

1972643070 — MS. CYNTHIA A SHEALY LCSW
Practice Location Address:

67 CHARLOTTE ST
ASHEVILLE, NC
28801-2435

Practice Phone: 828-505-6946
Practice Fax:

1003094764 — UMAR SERVICES, INC
Practice Location Address:

2435 UMAR CT
CHARLOTTE, NC
28215-3259

Practice Phone: 704-566-0245
Practice Fax:

1427226042 — MRS. MAGDALINA LEWIS LCSW, ACSW
Practice Location Address:

2432 RED BIRCH DR
CHARLOTTE, NC
28262-2435

Practice Phone: 704-957-0566
Practice Fax:

1750539938 — MS. KRISTY A CONNOR M.S. CCC-SLP
Practice Location Address:

4695 HACKBERRY GROVE CIR , APT 1922
CHARLOTTE, NC
28269-2435

Practice Phone: 631-806-6462
Practice Fax:

1437572187 — MICHAEL MCKEE RPH
Practice Location Address:

5634 WEDGEWOOD DR
CHARLOTTE, NC
28210-2435

Practice Phone: 704-909-9049
Practice Fax:

1659786531 — MRS. GRACE MARTIN SIMUNEK M.ED, BCBA
Practice Location Address:

4548 EMORY LN
CHARLOTTE, NC
28211-2435

Practice Phone: 774-930-9246
Practice Fax:

Directions to “ MISS PEGGY GREEN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.