Healthcare Provider Details

I. General information

NPI: 1619795663
Provider Name (Legal Business Name): PERFECT PEACE HOME & PERSONALIZED CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 PICKENS ST
MUSKOGEE OK
74401-4134
US

IV. Provider business mailing address

1615 PICKENS ST
MUSKOGEE OK
74401-4134
US

V. Phone/Fax

Practice location:
  • Phone: 945-213-8042
  • Fax:
Mailing address:
  • Phone: 945-213-8042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JBRIEL ELIZABETH PORTER
Title or Position: OWNER
Credential:
Phone: 945-213-8042