Organization
PEACHTREE VILLAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANET LYNN NORDLIE (OPERATING MANAGER)
(719) 200-3049
Entity
Organization
Contact information
Practice address
1500 FRESNO ST, FORT SMITH, AR 72901-7023
(479) 785-5544
Mailing address
24068 E 785 RD, WELLING, OK 74471-2356
(719) 200-3049
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
09/16/2019
Last updated
09/16/2019
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