Provider Demographics
NPI:1285210443
Name:AT PEACE HEALTH CARE AGENCY INC
Entity Type:Organization
Organization Name:AT PEACE HEALTH CARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:KOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-709-7530
Mailing Address - Street 1:314 N EAST ST STE 9
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-7503
Mailing Address - Country:US
Mailing Address - Phone:832-709-7530
Mailing Address - Fax:
Practice Address - Street 1:314 N EAST ST STE 9
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-7503
Practice Address - Country:US
Practice Address - Phone:832-709-7530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2547859Medicaid