=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003204751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACE HOMECARE, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2015
-----------------------------------------------------
Last Update Date | 01/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 N. UNIVERSITY BLVD. PEACE HOMECARE, LLC.
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-701-5951
-----------------------------------------------------
Fax | 405-701-5953
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 N. UNIVERSITY BLVD.
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-701-5951
-----------------------------------------------------
Fax | 405-701-5953
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | PAULETTA LINDA HARRELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-431-0699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | HC8024
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------