MEDICARE: PEACEFUL SURROUNDINGS HOME HEALTH CARE LLC

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

General Provider Information

NPI Number	:	1225493224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL SURROUNDINGS HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	3330 BOURBON ST
Second Line	:	STE 124
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22408-7333
Country	:	US
Telephone Number	:	540-373-3303
Fax Number	:	540-373-3330

Provider Business Practice Location Address
First Line	:	3330 BOURBON ST
Second Line	:	STE 124
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22408-7333
Country	:	US
Telephone Number	:	540-373-3303
Fax Number	:	540-373-3330

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHAVON M WILLIAMS
Credential	:
Telephone Number	:	540-373-3303

Provider Enumeration Date	:	12/18/2015
Last Update Date	:	12/18/2015

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