Healthcare Provider Details

I. General information

NPI: 1487302436
Provider Name (Legal Business Name): PEACEFUL ALTERNATIVES HOME HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W WASHINGTON ST STE 301
SUFFOLK VA
23434-5246
US

IV. Provider business mailing address

112 W WASHINGTON ST STE 301
SUFFOLK VA
23434-5246
US

V. Phone/Fax

Practice location:
  • Phone: 757-907-1512
  • Fax: 757-809-3829
Mailing address:
  • Phone: 757-907-1512
  • Fax: 757-809-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DADREA HARDEN FERGUSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-809-3856