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General NPI Number Information
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NPI Number | 1639936420
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Entity Type | Organization
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Legal Business Name | PEACE FOR REST ADULT SERVICES, LLC
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 7023 LEE PARK RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-3608
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Country | US
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Telephone | 804-229-9472
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Fax |
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Provider Business Mailing Address
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Address Line | 8355 E LORD BOTETOURT LOOP
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City | NEW KENT
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State | VA
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Zip | 23124-2871
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LEONA L BAYLOR
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Credential |
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Telephone | 804-572-8184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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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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