Healthcare Provider Details

I. General information

NPI: 1760943575
Provider Name (Legal Business Name): PEGGY'S PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 AUDUBON DR STE 100
NEW ALBANY IN
47150-3482
US

IV. Provider business mailing address

1730 AUDUBON DR STE 100
NEW ALBANY IN
47150-3482
US

V. Phone/Fax

Practice location:
  • Phone: 812-590-2857
  • Fax: 888-544-7301
Mailing address:
  • Phone: 812-590-2857
  • Fax: 888-544-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACY DIERS
Title or Position: PRESIDENT
Credential: RN
Phone: 812-913-4308