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General NPI Number Information
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NPI Number | 1023267218
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Entity Type | Organization
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Legal Business Name | HOSPICE PEACHTREE, LLC
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Dates
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Enumeration Date | 09/12/2008
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 2910 JENNY LIND RD #4
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City | FORT SMITH
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State | AR
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Zip | 72901-6735
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Country | US
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Telephone | 479-494-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 2910 JENNY LIND RD #4
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City | FORT SMITH
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State | AR
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Zip | 72901-6735
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JIM PETRUS
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Credential |
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Telephone | 479-494-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | AR 4137
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License Number State | AR
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