Provider Demographics
NPI:1225309040
Name:PEACHES-NA-BASKET ADULT HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:PEACHES-NA-BASKET ADULT HEALTH CARE SERVICES
Other - Org Name:PEACHES-NA-BASKET ADULT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:B.
Authorized Official - Middle Name:DOLORES
Authorized Official - Last Name:FLEMMING
Authorized Official - Suffix:
Authorized Official - Credentials:MSA
Authorized Official - Phone:904-766-4993
Mailing Address - Street 1:2040 SOUTEL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-2280
Mailing Address - Country:US
Mailing Address - Phone:904-766-4993
Mailing Address - Fax:904-766-4993
Practice Address - Street 1:2017 SOUTEL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208
Practice Address - Country:US
Practice Address - Phone:904-766-3195
Practice Address - Fax:904-330-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No253Z00000XAgenciesIn Home Supportive Care