Provider Demographics
NPI:1114123965
Name:PEACOCK ACRES, INC
Entity Type:Organization
Organization Name:PEACOCK ACRES, INC
Other - Org Name:PA 1
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANIZ
Authorized Official - Middle Name:BEZA
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-754-3635
Mailing Address - Street 1:251 OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93908-9760
Mailing Address - Country:US
Mailing Address - Phone:831-754-3635
Mailing Address - Fax:831-754-4733
Practice Address - Street 1:251 OLD STAGE RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93908-9760
Practice Address - Country:US
Practice Address - Phone:831-754-3635
Practice Address - Fax:831-754-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness