MEDICARE: A PEACEFUL PLACE CARE HOME 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1386489821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PEACEFUL PLACE CARE HOME LLC

Provider Business Mailing Address
First Line	:	12910 BROOK ARBOR CT
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-2592
Country	:	US
Telephone Number	:	832-672-5292
Fax Number	:

Provider Business Practice Location Address
First Line	:	5117 DIEPPE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-2634
Country	:	US
Telephone Number	:	832-672-5292
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHELLE BERNARD
Credential	:
Telephone Number	:	832-672-5292

Provider Enumeration Date	:	06/26/2024
Last Update Date	:	06/26/2024

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