Peachtree Lane at Mena, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

008 Issued in AR

Legal business name

PEACHTREE LANE AT MENA, LLC

Practice address

1803 Cordie Dr
Mena, AR 71953-9340

Phone

(479) 394-2600

Fax

(479) 394-2608

NPI assigned

Apr 20, 2007

Organization subpart

No

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

Authorized official

Name

Annette Landrum

Title

Managing Member Owner

Phone

(479) 783-0718

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740407493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1422 FRESNO ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729017065",
            "telephone_number": "479-783-0718",
            "fax_number": "479-783-8564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 CORDIE DR",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719539340",
            "telephone_number": "479-394-2600",
            "fax_number": "479-394-2608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE LANE AT MENA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LANDRUM",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "MANAGING MEMBER OWNER",
        "authorized_official_telephone_number": "479-783-0718"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AR",
            "license": "008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Julie Ann Pasquinzo, COUNSELOR, LPC
• Thomas Patterson
• Peachtree Mena LLC
• David C. Peppers, D.D.S.
• Valerie Marie Perez, APRN
• Karen Ann Perry
• Amy Lanelle Phelps, APRN

• Assisted Living Facility in Mena, AR
• Providers in Mena, AR by specialty
• Assisted Living Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.