Healthcare Provider Details

I. General information

NPI: 1881440865
Provider Name (Legal Business Name): PRINCE OF PEACE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12658 DUTCH CT
CORONA CA
92880-9279
US

IV. Provider business mailing address

12658 DUTCH CT
EASTVALE CA
92880-9279
US

V. Phone/Fax

Practice location:
  • Phone: 678-622-6131
  • Fax:
Mailing address:
  • Phone: 678-622-6131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: OLUWATOYIN OLADIMEJI
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 678-622-6131