Healthcare Provider Details

I. General information

NPI: 1932857679
Provider Name (Legal Business Name): PEACEFUL ALTERNATIVES HOME HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 03/11/2022
Certification Date: 09/04/2021
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: 757-808-3856
  • Fax: 757-809-3829
Mailing address:
  • Phone: 757-808-3856
  • Fax: 757-809-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: D'ADREA HARDEN FERGUSON
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 757-907-1512