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General NPI Number Information
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NPI Number | 1699543892
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Entity Type | Individual
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Provider Name | MARVIN PEASAH
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Gender | Male
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 3703 NATHANS WAY
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City | GREENSBORO
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State | NC
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Zip | 27405-9815
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Country | US
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Telephone | 336-807-2335
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Fax |
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Provider Business Mailing Address
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Address Line | 3703 NATHANS WAY
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City | GREENSBORO
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State | NC
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Zip | 27405-9815
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Country | US
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Telephone | 336-807-2335
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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