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General NPI Number Information
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NPI Number | 1538966130
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Entity Type | Organization
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Legal Business Name | POWER OF PEACE HOUSING AND RECOVERY SERVICE LLC
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Dates
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Enumeration Date | 03/01/2025
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Last Update Date | 03/01/2025
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Provider Practice Location Address
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Address Line | 4414 NICOLET DR BAY WI54311
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City | GREEN BAY
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State | WI
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Zip | 54311-1100
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Country | US
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Telephone | 920-371-1665
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Fax |
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Provider Business Mailing Address
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Address Line | 4414 NICOLET DR BAY WI54311
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City | GREEN BAY
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State | WI
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Zip | 54311-1100
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Country | US
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Telephone | 920-371-1665
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | WHITNEY R SANAPAW
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Credential | RECOVERY COACH, PEER
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Telephone | 920-371-1665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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