MEDICARE: PEBBLE CREEK HOMES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1407798952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEBBLE CREEK HOMES

Provider Business Mailing Address
First Line	:	19204 TEMPLE AVE
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5614
Country	:	US
Telephone Number	:	720-415-1845
Fax Number	:

Provider Business Practice Location Address
First Line	:	19204 TEMPLE AVE
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5614
Country	:	US
Telephone Number	:	720-415-1845
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SHANNON BROWN
Credential	:
Telephone Number	:	720-415-1845

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “PEBBLE CREEK HOMES ” Practice Location

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