Healthcare Provider Details

I. General information

NPI: 1235599184
Provider Name (Legal Business Name): HOUSE OF PEACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 SW 137TH AVE STE C-3
MIAMI FL
33175-6477
US

IV. Provider business mailing address

3905 SW 137TH AVE STE C-3
MIAMI FL
33175-6477
US

V. Phone/Fax

Practice location:
  • Phone: 305-400-9152
  • Fax: 888-979-6351
Mailing address:
  • Phone: 305-400-9152
  • Fax: 888-979-6351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHEYLA ACOSTA
Title or Position: CEO
Credential:
Phone: 305-360-9156