MEDICARE: PRINCE OF PEACE 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	333502	MN
2	251J00000X	Nursing Care Agency	333502	MN

General Provider Information

NPI Number	:	1659456291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCE OF PEACE INC.

Provider Business Mailing Address
First Line	:	6645 BRYANT AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-1804
Country	:	US
Telephone Number	:	763-245-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	6645 BRYANT AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-1804
Country	:	US
Telephone Number	:	763-245-9006
Fax Number	:

Authorized Official
Title or Position	:	NURSE
Name	:	MRS. MARIAM BOLANLE ALAGA
Credential	:
Telephone Number	:	763-245-9006

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/11/2025

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