Healthcare Provider Details

I. General information

NPI: 1194435016
Provider Name (Legal Business Name): PEACE OF MIND LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 W 73RD ST
INDIANAPOLIS IN
46278-1738
US

IV. Provider business mailing address

5650 W 73RD ST
INDIANAPOLIS IN
46278-1738
US

V. Phone/Fax

Practice location:
  • Phone: 317-468-5323
  • Fax:
Mailing address:
  • Phone: 317-468-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: JOSELYN MERRIWEATHER
Title or Position: OWNER
Credential:
Phone: 317-468-5323