Provider Demographics
NPI:1275074585
Name:PEACH TREE ASSISTED LIVING HOMES
Entity Type:Organization
Organization Name:PEACH TREE ASSISTED LIVING HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-866-9722
Mailing Address - Street 1:5164 SIMMONS BRANCH TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-7606
Mailing Address - Country:US
Mailing Address - Phone:919-866-9722
Mailing Address - Fax:919-803-1951
Practice Address - Street 1:502 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1604
Practice Address - Country:US
Practice Address - Phone:919-866-9722
Practice Address - Fax:919-803-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility