Provider Demographics
NPI:1285209130
Name:POM - PEACE OF MIND, LLC
Entity Type:Organization
Organization Name:POM - PEACE OF MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENA
Authorized Official - Middle Name:WATSON
Authorized Official - Last Name:NUAZEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-200-4357
Mailing Address - Street 1:4113 BARDSTOWN ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3292
Mailing Address - Country:US
Mailing Address - Phone:502-200-4357
Mailing Address - Fax:
Practice Address - Street 1:4113 BARDSTOWN ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3292
Practice Address - Country:US
Practice Address - Phone:502-200-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities