Provider Demographics
NPI:1598011017
Name:PEACH GARDENS PRIVATE HOME CARE
Entity Type:Organization
Organization Name:PEACH GARDENS PRIVATE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:CHERRI
Authorized Official - Last Name:KEYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-323-0280
Mailing Address - Street 1:PO BOX 6068
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31917-6068
Mailing Address - Country:US
Mailing Address - Phone:706-323-0280
Mailing Address - Fax:706-323-0288
Practice Address - Street 1:1323 11TH AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2201
Practice Address - Country:US
Practice Address - Phone:706-323-0280
Practice Address - Fax:706-323-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health