Provider Demographics
NPI:1225493224
Name:PEACEFUL SURROUNDINGS HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:PEACEFUL SURROUNDINGS HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAVON
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-373-3303
Mailing Address - Street 1:3330 BOURBON ST
Mailing Address - Street 2:STE 124
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7333
Mailing Address - Country:US
Mailing Address - Phone:540-373-3303
Mailing Address - Fax:540-373-3330
Practice Address - Street 1:3330 BOURBON ST
Practice Address - Street 2:STE 124
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7333
Practice Address - Country:US
Practice Address - Phone:540-373-3303
Practice Address - Fax:540-373-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health