MEDICARE: PEACEFUL 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	:	1285222810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	3447 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-1018
Country	:	US
Telephone Number	:	314-662-3637
Fax Number	:	314-800-2314

Provider Business Practice Location Address
First Line	:	3447 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-1018
Country	:	US
Telephone Number	:	314-662-3637
Fax Number	:	314-800-2314

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MOHAMED A MOHAMED
Credential	:
Telephone Number	:	314-662-3637

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	01/08/2021

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