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General NPI Number Information
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NPI Number | 1427539600
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Entity Type | Organization
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Legal Business Name | PEACHTREE VILLAGE OF FARMINGTON, LLC
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 55 W RAINSONG ST
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City | FARMINGTON
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State | AR
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Zip | 72730-8635
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Country | US
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Telephone | 479-267-3335
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Fax |
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Provider Business Mailing Address
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Address Line | 24068 E 785 RD
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City | WELLING
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State | OK
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Zip | 74471-2356
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Country | US
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Telephone | 719-200-3049
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Fax |
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | JANET LYNN NORDLIE
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Credential |
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Telephone | 719-200-3049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 054
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License Number State | AR
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