# PEACH STATE NURSING AGENCY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326119710
- **Authorized official:** MS. ROBIN LONG (PRESIDENT)
- **Authorized official phone:** (478) 453-3369

## Contact information

- **Practice address:** 140 W WASHINGTON ST, MILLEDGEVILLE, GA 31061-3434
- **Practice address phone:** (478) 453-3369
- **Practice address fax:** (478) 453-1131
- **Mailing address:** PO BOX 326, 140 WEST WASHINGTON ST., MILLEDGEVILLE, GA 31059-0326
- **Mailing address phone:** (478) 453-3369
- **Mailing address fax:** (478) 453-1131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 005-R-0003 | GA | Yes |

## Other

- **Enumeration date:** 11/10/2006
- **Last updated:** 08/22/2020