Provider Demographics
NPI:1376818179
Name:PEACEHAVEN HOMECARE, LLC
Entity Type:Organization
Organization Name:PEACEHAVEN HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DOBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-244-9565
Mailing Address - Street 1:169 YADKIN VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-8786
Mailing Address - Country:US
Mailing Address - Phone:336-998-6300
Mailing Address - Fax:
Practice Address - Street 1:169 YADKIN VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-8786
Practice Address - Country:US
Practice Address - Phone:336-998-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4519251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health