Healthcare Provider Details

I. General information

NPI: 1083598676
Provider Name (Legal Business Name): PEACHY ORCHARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 JUNIPER DR
CRESTVIEW FL
32536-9223
US

IV. Provider business mailing address

3313 FALCO RD
WING AL
36483-7101
US

V. Phone/Fax

Practice location:
  • Phone: 334-939-2170
  • Fax:
Mailing address:
  • Phone: 334-939-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ERATINA E OPEL
Title or Position: OWNER
Credential:
Phone: 334-939-2170