Provider Demographics
NPI:1235599184
Name:HOUSE OF PEACE, LLC
Entity Type:Organization
Organization Name:HOUSE OF PEACE, LLC
Other - Org Name:HOUSE OF PEACE HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHEYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-360-9156
Mailing Address - Street 1:3905 SW 137TH AVE STE C-3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6477
Mailing Address - Country:US
Mailing Address - Phone:305-400-9152
Mailing Address - Fax:888-979-6351
Practice Address - Street 1:3905 SW 137TH AVE STE C-3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6477
Practice Address - Country:US
Practice Address - Phone:305-400-9152
Practice Address - Fax:888-979-6351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018093500Medicaid