Healthcare Provider Details

I. General information

NPI: 1093946600
Provider Name (Legal Business Name): PEACE OF MIND SENIOR CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 MONROE ST 3B
EVANSTON IL
60202
US

IV. Provider business mailing address

1722 MONROE ST 3B
EVANSTON IL
60202
US

V. Phone/Fax

Practice location:
  • Phone: 773-310-9077
  • Fax:
Mailing address:
  • Phone: 773-310-9077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MISS DANA MAY GUY
Title or Position: PRESIDENT
Credential:
Phone: 773-310-9077