Healthcare Provider Details

I. General information

NPI: 1992869887
Provider Name (Legal Business Name): PEACE LILY DEVELOPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 PEACE LILLY LN
DOBSON NC
27017-8593
US

IV. Provider business mailing address

701 SOUTH MAIN STREET
DOBSON NC
27017-8593
US

V. Phone/Fax

Practice location:
  • Phone: 336-813-3908
  • Fax: 336-356-2601
Mailing address:
  • Phone: 336-813-3908
  • Fax: 336-356-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License NumberMHL086034
License Number StateNC

VIII. Authorized Official

Name: KHALIL SAID NASSAR
Title or Position: CEO/OWNER
Credential:
Phone: 336-813-3908