=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073556171
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7014 HWY 71
-----------------------------------------------------
City | PALMETTO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-623-4227
-----------------------------------------------------
Fax | 337-623-5602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7014 HWY 71
-----------------------------------------------------
City | PALMETTO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-623-4227
-----------------------------------------------------
Fax | 337-623-5602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. GERARD LACOUR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-623-4227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 444
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------