Healthcare Provider Details

I. General information

NPI: 1437690294
Provider Name (Legal Business Name): PEACE OF MIND HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N. PLANKINTON AVE SUITE 302
MILWAUKEE WI
53203
US

IV. Provider business mailing address

600 N. PLANKINTON AVE SUITE 302
MILWAUKEE WI
53203
US

V. Phone/Fax

Practice location:
  • Phone: 414-755-9309
  • Fax: 414-755-7696
Mailing address:
  • Phone: 414-755-9309
  • Fax: 414-755-7696

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: OLGA VAN BIBBER
Title or Position: ADMINISTRATOR
Credential:
Phone: 414-755-9309