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General NPI Number Information
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NPI Number | 1598490245
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Entity Type | Organization
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Legal Business Name | PRINCE OF PEACE HOME CARE SERVICES LLC
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 35490 PONY TRAIL RD
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City | HEMET
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State | CA
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Zip | 92545-2124
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Country | US
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Telephone | 951-639-7809
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Fax |
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Provider Business Mailing Address
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Address Line | 35490 PONY TRAIL RD
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City | HEMET
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State | CA
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Zip | 92545-2124
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Country | US
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Telephone | 951-639-7809
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DARNELL BAILEY SR.
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Credential |
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Telephone | 951-992-3545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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