Healthcare Provider Details

I. General information

NPI: 1922425370
Provider Name (Legal Business Name): PEACE AT HOME NURSING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9407 NE 166TH AVE
VANCOUVER WA
98682-1592
US

IV. Provider business mailing address

9407 NE 166TH AVE
VANCOUVER WA
98682-1592
US

V. Phone/Fax

Practice location:
  • Phone: 360-949-5658
  • Fax: 541-647-6554
Mailing address:
  • Phone: 360-949-5658
  • Fax: 541-647-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA JOY BELLUS
Title or Position: OWNER
Credential: RN BSN
Phone: 360-949-5658