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General NPI Number Information
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NPI Number | 1700418977
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Entity Type | Organization
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Legal Business Name | PEACEFUL CARE LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 2415 ANNAPOLIS LN N STE 130
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City | PLYMOUTH
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State | MN
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Zip | 55441-3632
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Country | US
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Telephone | 612-701-6094
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Fax | 763-205-6574
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Provider Business Mailing Address
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Address Line | 10560 AUBURNDALE RD
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City | CHAGRIN FALLS
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State | OH
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Zip | 44023-2344
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Country | US
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Telephone | 952-201-3381
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Fax | 612-234-4361
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | ROGER CREWS
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Credential |
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Telephone | 612-701-6094
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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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