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General NPI Number Information
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NPI Number | 1508126293
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND ADULT GROUP HOME
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 703 BAYBERY LN
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City | NASHVILLE
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State | NC
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Zip | 27856-1578
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Country | US
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Telephone | 252-462-5483
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Fax | 252-462-5483
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Provider Business Mailing Address
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Address Line | 703 BAYBERY LN
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City | NASHVILLE
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State | NC
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Zip | 27856-1578
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Country | US
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Telephone | 252-462-5483
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Fax | 252-462-5483
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Authorized Official
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Title or Position | ADMINISTRATO/OWNER
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Name | JENNIFER GARY-PETERSON
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Credential |
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Telephone | 252-462-5483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 064131
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License Number State | NC
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