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General NPI Number Information
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NPI Number | 1356945562
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Entity Type | Organization
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Legal Business Name | PEACOCK DESERT ROSE SERVICES LIMITED
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Dates
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Enumeration Date | 11/29/2020
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Last Update Date | 11/29/2020
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Provider Practice Location Address
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Address Line | 967 KENDALL DR # A329
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4306
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Country | US
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Telephone | 909-689-6095
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Fax |
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Provider Business Mailing Address
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Address Line | 967 KENDALL DR # A329
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4306
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Country | US
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Telephone | 909-689-6095
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAI HARPER
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Credential |
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Telephone | 909-689-6095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number |
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License Number State |
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