MEDICARE: PEACEFUL LIFE 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1699634485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL LIFE LLC

Provider Business Mailing Address
First Line	:	30400 DETROIT RD STE 301
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1855
Country	:	US
Telephone Number	:	440-665-2266
Fax Number	:

Provider Business Practice Location Address
First Line	:	30400 DETROIT RD STE 301
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1855
Country	:	US
Telephone Number	:	440-665-2266
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JODI WALTERS
Credential	:	LISW
Telephone Number	:	440-665-2266

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/21/2026

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Directions to “PEACEFUL LIFE LLC ” Practice Location

Language	Start Address	Practice Location

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