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General NPI Number Information
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NPI Number | 1144364514
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Entity Type | Organization
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Legal Business Name | PEACHTREE HEALTHCARE
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Dates
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Enumeration Date | 02/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 939 5 OAKS AVE
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City | DAYTON
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State | OH
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Zip | 45406-5225
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Country | US
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Telephone | 937-789-0456
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Fax |
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Provider Business Mailing Address
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Address Line | 939 5 OAKS AVE
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City | DAYTON
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State | OH
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Zip | 45406-5225
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Country | US
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Telephone | 937-789-0456
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ERICA RENEE WHEATON
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Credential |
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Telephone | 937-789-0456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 373236921296
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License Number State | OH
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