MEDICARE: A PEACEFUL HEART HOME 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1619491016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PEACEFUL HEART HOME CARE LLC

Provider Business Mailing Address
First Line	:	5750 RUFE SNOW DR STE 135
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6167
Country	:	US
Telephone Number	:	888-482-6116
Fax Number	:	877-211-9810

Provider Business Practice Location Address
First Line	:	5750 RUFE SNOW DR STE 135
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6167
Country	:	US
Telephone Number	:	888-482-6116
Fax Number	:	877-211-9810

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. RACHEL CHOMBA
Credential	:
Telephone Number	:	888-482-6116

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	07/21/2022

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