NPI Code Detail JSON Logo

1013660612 NPI number — PEACE OF MIND COMMUNITY CARE, LLC

NPI Number: 1013660612
Health Care Provider/Practitioner: PEACE OF MIND COMMUNITY CARE, LLC

Information about “1013660612” NPI (PEACE OF MIND COMMUNITY CARE, LLC) exists in 1013660612 in HTML format HTML  |  1013660612 in plain Text format TXT  |  1013660612 in PDF (Portable Document Format) PDF  |  1013660612 in an XML format XML  formats.

NPI Number : 1013660612 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1013660612",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "PEACE OF MIND FAMILY HOME CARE, LLC",
    "ParentOrgTIN": null,
    "OrgName": "PEACE OF MIND COMMUNITY CARE, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2604 GRIMSLEY ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREENSBORO",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27403-3136",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "743-258-9540",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2031 MARTIN LUTHER KING JR DR STE D3",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREENSBORO",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27406-3342",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "743-258-9540",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/02/2022",
    "LastUpdateDate": "03/24/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CLEMONTS",
    "AuthorizedOfficialFirstName": "ALEXIS",
    "AuthorizedOfficialMiddleName": "MISHAWN",
    "AuthorizedOfficialTitle": "OWNER/AGENCY DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "743-258-9540",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "385HR2065X",
          "TaxonomyName": "Child Physical Disabilities Respite Care",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "347C00000X",
          "TaxonomyName": "Private Vehicle",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "385H00000X",
          "TaxonomyName": "Respite Care",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "385HR2055X",
          "TaxonomyName": "Child Mental Illness Respite Care",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "385HR2060X",
          "TaxonomyName": "Child Intellectual and/or Developmental Disabilities Respite Care",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QA0600X",
          "TaxonomyName": "Adult Day Care Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "291U00000X",
          "TaxonomyName": "Clinical Medical Laboratory",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "253Z00000X",
          "TaxonomyName": "In Home Supportive Care Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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