Provider Demographics
NPI:1417230764
Name:AT PEACE HEALTH CARE AGENCY LLC
Entity Type:Organization
Organization Name:AT PEACE HEALTH CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:267-591-8062
Mailing Address - Street 1:3222 W CHELTENHAM AVE
Mailing Address - Street 2:SUITE A1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1003
Mailing Address - Country:US
Mailing Address - Phone:215-525-6441
Mailing Address - Fax:
Practice Address - Street 1:3222 W CHELTENHAM AVE
Practice Address - Street 2:SUITE A1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1003
Practice Address - Country:US
Practice Address - Phone:215-525-6441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04500501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health