Provider Demographics
NPI:1144364514
Name:PEACHTREE HEALTHCARE
Entity type:Organization
Organization Name:PEACHTREE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WHEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-789-0456
Mailing Address - Street 1:939 5 OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-5225
Mailing Address - Country:US
Mailing Address - Phone:937-789-0456
Mailing Address - Fax:
Practice Address - Street 1:939 5 OAKS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5225
Practice Address - Country:US
Practice Address - Phone:937-789-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH373236921296251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health