MEDICARE: PEACEFUL LIVING ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		CO

General Provider Information

NPI Number	:	1104036045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL LIVING ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	5245 CENTENNIAL BLVD STE 202
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-4405
Country	:	US
Telephone Number	:	719-522-9100
Fax Number	:	719-520-0590

Provider Business Practice Location Address
First Line	:	5245 CENTENNIAL BLVD STE 202
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-4405
Country	:	US
Telephone Number	:	719-522-9100
Fax Number	:	719-520-0590

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JANET MARIE VANOSTENBRIDGE
Credential	:
Telephone Number	:	719-522-9100

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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