MEDICARE: HOSPICE PEACHTREE LLC

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	251G00000X	Community Based Hospice Care Agency

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

General Provider Information

NPI Number	:	1275513129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE PEACHTREE LLC

Provider Business Mailing Address
First Line	:	2910 JENNY LIND RD
Second Line	:	#4
City	:	FORT SMITH
State	:	AR
Zip	:	72901-6735
Country	:	US
Telephone Number	:	479-494-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2910 JENNY LIND RD
Second Line	:	#4
City	:	FORT SMITH
State	:	AR
Zip	:	72901-6735
Country	:	US
Telephone Number	:	479-494-0100
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. JIM PETRUS
Credential	:
Telephone Number	:	479-494-0100

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/23/2010

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Directions to “HOSPICE PEACHTREE LLC ” Practice Location

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