Provider Demographics
NPI:1437868239
Name:PEACH CREEK ALF 1 LLC
Entity Type:Organization
Organization Name:PEACH CREEK ALF 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:979-431-4135
Mailing Address - Street 1:1488 STOKES CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8772
Mailing Address - Country:US
Mailing Address - Phone:979-431-4135
Mailing Address - Fax:855-662-8109
Practice Address - Street 1:1488 STOKES CIR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8772
Practice Address - Country:US
Practice Address - Phone:979-431-4135
Practice Address - Fax:855-662-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No385H00000XRespite Care FacilityRespite Care