Provider Demographics
NPI:1508460619
Name:PEACHSTATE HOMECARE, LLC
Entity Type:Organization
Organization Name:PEACHSTATE HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DABBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-744-3928
Mailing Address - Street 1:6030 BETHELVIEW RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8021
Mailing Address - Country:US
Mailing Address - Phone:770-744-3928
Mailing Address - Fax:470-239-3335
Practice Address - Street 1:6030 BETHELVIEW RD STE 103
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8021
Practice Address - Country:US
Practice Address - Phone:770-744-3928
Practice Address - Fax:470-239-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care