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General NPI Number Information
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NPI Number | 1235828559
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Entity Type | Organization
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Legal Business Name | PEARTREE HEALTH CARE
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 1905 WOMACK DRIVE HAMPTON VA 23663
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City | HAMPTON
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State | VA
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Zip | 23663
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Country | US
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Telephone | 757-561-9876
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 WOMACK DRIVE HAMPTON VA 23663
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City | HAMPTON
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State | VA
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Zip | 23663
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Country | US
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Telephone | 757-561-9876
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KHALID DEANDRE PEARTREE
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Credential | CNA , MEDICATION AID
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Telephone | 757-561-9876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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