Healthcare Provider Details

I. General information

NPI: 1912383530
Provider Name (Legal Business Name): PEACE HOME AND HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6523 REDGATE CIR
BALTIMORE MD
21228-1146
US

IV. Provider business mailing address

6523 REDGATE CIR
BALTIMORE MD
21228-1146
US

V. Phone/Fax

Practice location:
  • Phone: 443-804-7141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR130631
License Number StateMD

VIII. Authorized Official

Name: NNENE UKOHA
Title or Position: OWNER
Credential:
Phone: 443-804-7141