Provider Demographics
NPI:1083598676
Name:PEACHY ORCHARD LLC
Entity type:Organization
Organization Name:PEACHY ORCHARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERATINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:OPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-939-2170
Mailing Address - Street 1:3313 FALCO RD
Mailing Address - Street 2:
Mailing Address - City:WING
Mailing Address - State:AL
Mailing Address - Zip Code:36483-7101
Mailing Address - Country:US
Mailing Address - Phone:334-939-2170
Mailing Address - Fax:
Practice Address - Street 1:412 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-9223
Practice Address - Country:US
Practice Address - Phone:334-939-2170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services