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NPI Code Detail

MEDICARE: HOSPICE PEACHTREE LLC

MEDICARE: HOSPICE PEACHTREE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251G00000XCommunity Based Hospice Care Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275513129
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOSPICE PEACHTREE LLC
Provider Business Mailing Address
First Line : 2910 JENNY LIND RD
Second Line : #4
City : FORT SMITH
State : AR
Zip : 72901-6735
Country : US
Telephone Number : 479-494-0100
Fax Number :
Provider Business Practice Location Address
First Line : 2910 JENNY LIND RD
Second Line : #4
City : FORT SMITH
State : AR
Zip : 72901-6735
Country : US
Telephone Number : 479-494-0100
Fax Number :
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : MR. JIM PETRUS
Credential :
Telephone Number : 479-494-0100
Provider Enumeration Date : 01/18/2006
Last Update Date : 07/23/2010

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Directions to “HOSPICE PEACHTREE LLC ” Practice Location

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