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General NPI Number Information
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NPI Number | 1508682642
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Entity Type | Organization
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Legal Business Name | PEACEFUL PATH LIVING, LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 50 NORWOOD ST
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City | REDLANDS
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State | CA
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Zip | 92373-6315
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Country | US
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Telephone | 562-412-5474
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Fax |
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Provider Business Mailing Address
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Address Line | 2271 W MALVERN AVE # 1013
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City | FULLERTON
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State | CA
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Zip | 92833-2106
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Country | US
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Telephone | 562-412-5474
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAMES PARK
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Credential |
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Telephone | 562-412-5474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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