Healthcare Provider Details

I. General information

NPI: 1346541976
Provider Name (Legal Business Name): PEACE OF MIND HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 BECK RD STE C
SAINT JOSEPH MO
64506-2071
US

IV. Provider business mailing address

3723 BECK RD STE C
SAINT JOSEPH MO
64506-2071
US

V. Phone/Fax

Practice location:
  • Phone: 816-671-0298
  • Fax: 816-396-5909
Mailing address:
  • Phone: 816-671-0298
  • Fax: 816-396-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberLC1098497
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0011472-2
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number0011472
License Number StateMO

VIII. Authorized Official

Name: MR. JASON DOUGLAS
Title or Position: MANAGING MEMBER/CEO
Credential:
Phone: 816-617-1225