Healthcare Provider Details

I. General information

NPI: 1487460002
Provider Name (Legal Business Name): MATTIEIDA'S PEACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 S REILLY LN
NEW PALESTINE IN
46163-8560
US

IV. Provider business mailing address

1868 S REILLY LN
NEW PALESTINE IN
46163-8560
US

V. Phone/Fax

Practice location:
  • Phone: 317-617-8104
  • Fax: 317-449-7835
Mailing address:
  • Phone: 317-617-8104
  • Fax: 317-449-7835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: NEACHE HOOD
Title or Position: CEO
Credential:
Phone: 317-617-8104