MEDICARE: PEACE OF MIND HOME CARE AGENCY, LLC

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	251E00000X	Home Health Agency	HCO-171532	VA

General Provider Information

NPI Number	:	1851843635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE OF MIND HOME CARE AGENCY, LLC

Provider Business Mailing Address
First Line	:	2737 CAMPOSTELLA RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-3656
Country	:	US
Telephone Number	:	757-226-0261
Fax Number	:	757-233-6661

Provider Business Practice Location Address
First Line	:	2737 CAMPOSTELLA RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-3656
Country	:	US
Telephone Number	:	757-226-0261
Fax Number	:	757-233-6661

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JANICE SHERREY STATON
Credential	:
Telephone Number	:	757-632-6824

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	10/27/2016

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