Healthcare Provider Details

I. General information

NPI: 1235828559
Provider Name (Legal Business Name): PEARTREE HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 WOMACK DRIVE HAMPTON VA 23663
HAMPTON VA
23663
US

IV. Provider business mailing address

1905 WOMACK DRIVE HAMPTON VA 23663
HAMPTON VA
23663
US

V. Phone/Fax

Practice location:
  • Phone: 757-561-9876
  • Fax:
Mailing address:
  • Phone: 757-561-9876
  • 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 Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: KHALID DEANDRE PEARTREE
Title or Position: OWNER
Credential: CNA , MEDICATION AID
Phone: 757-561-9876