Provider Demographics
NPI:1073236022
Name:PEACE ALLIANCE SERVICES LLC
Entity Type:Organization
Organization Name:PEACE ALLIANCE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUKARWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-238-0595
Mailing Address - Street 1:3360 COLD HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-9643
Mailing Address - Country:US
Mailing Address - Phone:317-238-0595
Mailing Address - Fax:
Practice Address - Street 1:3360 COLD HARBOR DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-9643
Practice Address - Country:US
Practice Address - Phone:317-238-0595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No177F00000XOther Service ProvidersLodging
No251E00000XAgenciesHome Health
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness