=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508655168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACEFUL NURSING SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2025
-----------------------------------------------------
Last Update Date | 05/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 909 RIESLING CT
-----------------------------------------------------
City | WALTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41094-6501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-669-0469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 93
-----------------------------------------------------
City | HEBRON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41048-0093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-669-0469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | PEACE YEBOAH
-----------------------------------------------------
Credential | OWNER
-----------------------------------------------------
Telephone | 859-669-0469
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------