Healthcare Provider Details

I. General information

NPI: 1275513129
Provider Name (Legal Business Name): HOSPICE PEACHTREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 JENNY LIND RD #4
FORT SMITH AR
72901-6735
US

IV. Provider business mailing address

2910 JENNY LIND RD #4
FORT SMITH AR
72901-6735
US

V. Phone/Fax

Practice location:
  • Phone: 479-494-0100
  • Fax:
Mailing address:
  • Phone: 479-494-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM PETRUS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 479-494-0100