Healthcare Provider Details

I. General information

NPI: 1134064181
Provider Name (Legal Business Name): PEACEFULLY POLISHED SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 E IDLEWILD AVE
EUSTIS FL
32726-6450
US

IV. Provider business mailing address

421 E IDLEWILD AVE
EUSTIS FL
32726-6450
US

V. Phone/Fax

Practice location:
  • Phone: 352-272-6209
  • Fax:
Mailing address:
  • Phone: 352-272-6209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: VERONICA RENAY JOHNSON
Title or Position: MANAGER
Credential:
Phone: 352-272-6209