MEDICARE: PEACHTREE CARE HEALTH SERVICES

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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health 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	:	1548916380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACHTREE CARE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	3550 LENOX RD NE FL 21
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-4334
Country	:	US
Telephone Number	:	404-886-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 LENOX RD NE FL 21
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-4334
Country	:	US
Telephone Number	:	404-886-0555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SABI VARON
Credential	:
Telephone Number	:	404-886-0555

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	03/01/2022

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