Provider Demographics
NPI:1700596087
Name:PEACHTREE HEALTHCARE LLC
Entity Type:Organization
Organization Name:PEACHTREE HEALTHCARE LLC
Other - Org Name:PEACHTREE HEALTHCARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON-HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-825-6089
Mailing Address - Street 1:5060 N 19TH AVE STE 421
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3214
Mailing Address - Country:US
Mailing Address - Phone:706-825-6089
Mailing Address - Fax:
Practice Address - Street 1:5060 N 19TH AVE STE 421
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3214
Practice Address - Country:US
Practice Address - Phone:706-825-6089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)