Healthcare Provider Details

I. General information

NPI: 1275451700
Provider Name (Legal Business Name): PEACHTREE RESIDENTIAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 4TH ST SW
CANTON OH
44707-4608
US

IV. Provider business mailing address

1020 4TH ST SW
CANTON OH
44707-4608
US

V. Phone/Fax

Practice location:
  • Phone: 330-571-9940
  • Fax: 234-214-0428
Mailing address:
  • Phone: 330-571-9940
  • Fax: 234-214-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT SMITH III
Title or Position: CEO
Credential: DO
Phone: 330-571-9940