Healthcare Provider Details

I. General information

NPI: 1972921815
Provider Name (Legal Business Name): PEACE IN THE CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 OLD WAGY RD
FOREST CITY NC
28043-9466
US

IV. Provider business mailing address

PO BOX 987
FOREST CITY NC
28043-0987
US

V. Phone/Fax

Practice location:
  • Phone: 828-429-1811
  • Fax:
Mailing address:
  • Phone: 828-429-1811
  • Fax: 828-382-0066

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 Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. MICHELLE ALLEN LATTIMORE
Title or Position: EXECUTIVE DIRECTOR
Credential: BACHELOR OF SCIENCE
Phone: 828-429-1811