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General NPI Number Information
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NPI Number | 1568097723
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Entity Type | Organization
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Legal Business Name | PEACE AT LAST PRIVATE HOME CARE LLC.
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Dates
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Enumeration Date | 03/09/2020
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 5596 MAYFAIR CROSSING DR
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City | LITHONIA
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State | GA
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Zip | 30038-1182
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Country | US
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Telephone | 770-905-3544
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Fax |
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Provider Business Mailing Address
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Address Line | 5596 MAYFAIR CROSSING DR
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City | LITHONIA
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State | GA
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Zip | 30038-1182
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Country | US
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Telephone | 770-905-3544
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | NAKESHA MCMINNS
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Credential |
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Telephone | 470-246-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number |
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License Number State | NULL
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Taxonomy #5
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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 | NULL
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