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Organization Active NPI

Hospice Peachtree LLC

  • Community Based Hospice Care Agency
  • Fort Smith, AR
National Provider Identifier
1275513129
Registry record updated Jul 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
HOSPICE PEACHTREE LLC
Practice address
2910 Jenny Lind Rd
#4
Fort Smith, AR 72901-6735
Phone
(479) 494-0100
NPI assigned
Jan 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jim Petrus
Title
Chief Operating Officer
Phone
(479) 494-0100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

2910 Jenny Lind Rd
#4
Fort Smith, AR 72901-6735

Mailing address

2910 Jenny Lind Rd
#4
Fort Smith, AR 72901-6735
Phone (479) 494-0100

Other identifiers 1

IdentifierTypeStateIssuer
141698747MedicaidAR

Other names 1

  • Peachtree Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Locations

4300 Rogers Ave
Ste 33
Fort Smith, AR 72903
Phone (479) 494-0100

4300 Rogers Ave
#33
Fort Smith, AR 72903
Phone (479) 494-0100

4425 Jefferson Ave
Ste 104
Texarkana, AR 71854
Phone (870) 773-4353

2413 Texas Blvd
Texarkana, TX 75503
Phone (866) 210-4125

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Marcia Clement Individual 5% Or Greater Indirect Ownership Interest Sep 20, 2000 12.6%
Samuel E Landrum Individual 5% Or Greater Direct Ownership InterestPartner Nov 25, 2011 19%
William H. Hanna, Exempt Child'S Trust Organization, Fort Smith, AR 5% Or Greater Indirect Ownership Interest Sep 20, 2000 12.7%
Tommy Beard Individual 5% Or Greater Indirect Ownership Interest Sep 20, 2000 12.7%
James Petrus Individual 5% Or Greater Direct Ownership InterestChief Executive Officer Jul 1, 2008 5%
Corporate Director Sep 1, 2006
W-2 Managing EmployeeChief Operating Officer Sep 20, 2000 100%
Kimberly H. Behrend, Exempt Child'S Trust Organization, Fort Smith, AR 5% Or Greater Indirect Ownership Interest Sep 20, 2000 12.6%
Hanna Family Investments LP Organization, Fort Smith, AR 5% Or Greater Direct Ownership Interest Sep 20, 2000 38%
Miller Investments, LLC Organization, Fort Smith, AR LLC 5% Or Greater Direct Ownership Interest Sep 20, 2000 38%
Michael M. Hanna, Child'S Trust Organization, Fort Smith, AR 5% Or Greater Indirect Ownership Interest Sep 20, 2000 12.7%
Michael Miller Individual 5% Or Greater Indirect Ownership Interest Sep 20, 2000 12.7%

Change-of-ownership history 1

DateEventCounterparty
Aug 1, 2018 Change of OwnershipThis provider was the seller Heart of Hospice, LLCCCN 041547, AR, NPI 1619457181

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279843200000",
    "number": "1275513129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 JENNY LIND RD",
            "address_2": "#4",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729016735",
            "telephone_number": "479-494-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2910 JENNY LIND RD",
            "address_2": "#4",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729016735",
            "telephone_number": "479-494-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE PEACHTREE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-18",
        "last_updated": "2010-07-23",
        "status": "A",
        "authorized_official_last_name": "PETRUS",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "479-494-0100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141698747",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peachtree Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Smith, AR

Sources for this page

Verify at the official NPI Registry.