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General NPI Number Information
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NPI Number | 1730758970
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Entity Type | Organization
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Legal Business Name | PEACE RESIDENTIAL CARE HOME, INC
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 38 S VESPER BEND CIR
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City | SPRING
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State | TX
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Zip | 77382-5519
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Country | US
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Telephone | 347-841-5030
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Fax | 713-429-0750
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Provider Business Mailing Address
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Address Line | 38 S VESPER BEND CIR
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City | SPRING
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State | TX
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Zip | 77382-5519
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Country | US
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Telephone | 347-841-5030
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Fax | 713-429-0750
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Authorized Official
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Title or Position | CONSULTANT
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Name | ELLEN CLINTON
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Credential |
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Telephone | 817-903-7600
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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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