Healthcare Provider Details

I. General information

NPI: 1932984184
Provider Name (Legal Business Name): PEPPERMINT PALM HOME HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 SE 163RD LN
SUMMERFIELD FL
34491-5948
US

IV. Provider business mailing address

10017 FEDERALIST LN
SACRAMENTO CA
95827-1934
US

V. Phone/Fax

Practice location:
  • Phone: 916-212-9987
  • Fax: 888-962-6462
Mailing address:
  • Phone: 916-212-9987
  • Fax: 888-962-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ALFEAR NELSON WRIGHT
Title or Position: PRESIDENT
Credential:
Phone: 916-212-9987