MEDICARE: PEACE OF HOPE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility		GA
2	311ZA0620X	Adult Care Home Facility		GA

General Provider Information

NPI Number	:	1477843886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE OF HOPE, INC.

Provider Business Mailing Address
First Line	:	2236 CAROLINA WIND CT
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2579
Country	:	US
Telephone Number	:	404-957-5693
Fax Number	:

Provider Business Practice Location Address
First Line	:	2236 CAROLINA WIND CT
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2579
Country	:	US
Telephone Number	:	404-957-5693
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	SHIRLEY MOORE
Credential	:
Telephone Number	:	404-957-5693

Provider Enumeration Date	:	04/19/2011
Last Update Date	:	04/19/2011

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Directions to “PEACE OF HOPE, INC. ” Practice Location

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