Organization Name: | HOSPICE PEACHTREE, LLC |
NPI Number: | 1184887572 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JIM PETRUS (CHIEF OPERATING OFFICER) |
Mailing Address: | 3100 N Broadway St Poteau |
State: | OK US |
Postal Code: | 749535428 |
Phone Number: | 9186477008 |
Fax Number: | 9186477168 |
NPI Enumeration Date: | 07/07/2008 |
NPI Last Update Date: | 07/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | 4057 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |