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General NPI Number Information
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NPI Number | 1578201059
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Entity Type | Organization
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Legal Business Name | PALACE OF PEACE INC
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 5436 101ST ST APT 3
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City | JACKSONVILLE
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State | FL
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Zip | 32210-8910
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Country | US
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Telephone | 904-559-5327
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28582
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City | JACKSONVILLE
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State | FL
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Zip | 32226-8582
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Country | US
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Telephone | 904-559-5327
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MS. TANISHA MOORE
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Credential |
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Telephone | 904-559-5327
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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 |
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Taxonomy #2
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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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 |
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