PEACH TREE HEALTHCARE NPI 1164886040

NPI Information

NPI: 1164886040
Provider Name: PEACH TREE HEALTHCARE

Other Name: PEACH TREE NORTH SACRAMENTO

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
3810 ROSIN CT
SUITE 100
SACRAMENTO, CA
ZIP 95834
Phone: (530) 741-6245
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PEACH TREE HEALTHCARE is a federally qualified health center (fqhc) clinic center in Sacramento, CA. PEACH TREE HEALTHCARE NPI is 1164886040. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Peach Tree North Sacramento.

The provider's business location address is:

3810 ROSIN CT
SUITE 100
SACRAMENTO, CA
ZIP 95834-656
Phone: (530) 741-6245
Fax: (530) 741-9274

The provider's authorized official is Greg S Stone .
The authorized official title is Ceo and has the following contact phone number (530) 741-6245.

The CLIA number assigned to this NPI record is 05D0616752 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 4/7/2016 and was last updated on 5/23/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	171M00000X	Case Manager/Care Coordinator				No
2	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	030000463	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	751916	OTHER	CALIFORNIA	PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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