MEDICARE: HELEN'S PEACE HOME HEALTHCARE, 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1942559968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HELEN'S PEACE HOME HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	6111 KENILWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-1223
Country	:	US
Telephone Number	:	832-516-8983
Fax Number	:

Provider Business Practice Location Address
First Line	:	6111 KENILWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-1223
Country	:	US
Telephone Number	:	832-516-8983
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ ADMINISTRATOR
Name	:	MISS DEMETRIA DESHON LUCKETT
Credential	:
Telephone Number	:	832-516-8983

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	10/18/2012

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