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General NPI Number Information
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NPI Number | 1619795663
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Entity Type | Organization
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Legal Business Name | PERFECT PEACE HOME & PERSONALIZED CARE
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 1615 PICKENS ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-4134
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Country | US
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Telephone | 945-213-8042
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 STATE HIGHWAY 121 APT 2125
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City | LEWISVILLE
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State | TX
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Zip | 75056-4320
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Country | US
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Telephone | 945-213-8042
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JBRIEL ELIZABETH PORTER
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Credential |
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Telephone | 945-213-8042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 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 |
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