Healthcare Provider Details

I. General information

NPI: 1831842368
Provider Name (Legal Business Name): PEACH RETREAT HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 LAMBTOWN RD
VIENNA GA
31092-7102
US

IV. Provider business mailing address

3260 LAMBTOWN RD
VIENNA GA
31092-7102
US

V. Phone/Fax

Practice location:
  • Phone: 229-521-1051
  • Fax:
Mailing address:
  • Phone: 229-521-1051
  • Fax:

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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. LABOCCIA OGUNLEWE
Title or Position: CEO
Credential: RN
Phone: 727-483-3477