Organization
HOSPICE PEACHTREE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM PETRUS (CHIEF OPERATING OFFICER)
(479) 494-0100
Entity
Organization
Contact information
Practice address
3100 N BROADWAY ST, POTEAU, OK 74953-5428
(918) 647-7008
(918) 647-7168
Mailing address
PO BOX 460, POTEAU, OK 74953-0460
(918) 647-7008
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
4057
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100679750 B
—
OK
Enumeration date
07/07/2008
Last updated
07/07/2008
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