Provider Demographics
NPI:1821461963
Name:PEACHTREE OPERATING GROUP LLC
Entity Type:Organization
Organization Name:PEACHTREE OPERATING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANSHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-513-4558
Mailing Address - Street 1:544 PARK AVE STE B04
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1434 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-4734
Practice Address - Country:US
Practice Address - Phone:864-487-2717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility