Healthcare Provider Details

I. General information

NPI: 1245144377
Provider Name (Legal Business Name): PEACH TREE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 ROSIN CT STE 170
SACRAMENTO CA
95834-1699
US

IV. Provider business mailing address

1114 YUBA ST STE 220
MARYSVILLE CA
95901-4838
US

V. Phone/Fax

Practice location:
  • Phone: 530-749-3242
  • Fax: 530-749-3248
Mailing address:
  • Phone: 530-749-3242
  • Fax: 530-749-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL

VIII. Authorized Official

Name: GREG BARKER
Title or Position: CFO
Credential:
Phone: 530-749-3242