Healthcare Provider Details

I. General information

NPI: 1679482368
Provider Name (Legal Business Name): HOOVER'S PEACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 WILSON AVE
OSAGE WY
82723-5063
US

IV. Provider business mailing address

PO BOX 121
NEWCASTLE WY
82701-0121
US

V. Phone/Fax

Practice location:
  • Phone: 307-629-0382
  • Fax:
Mailing address:
  • Phone: 307-629-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBRA JAN LAKE
Title or Position: OWNER
Credential:
Phone: 307-629-0382