Healthcare Provider Details

I. General information

NPI: 1821461963
Provider Name (Legal Business Name): PEACHTREE OPERATING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 N LIMESTONE ST
GAFFNEY SC
29340-4734
US

IV. Provider business mailing address

544 PARK AVE STE B04
BROOKLYN NY
11205-1670
US

V. Phone/Fax

Practice location:
  • Phone: 864-487-2717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ANSHEL NIEDERMAN
Title or Position: MANAGER/MEMBER
Credential:
Phone: 718-513-4558