Provider Demographics
NPI:1477624930
Name:PEACE OF MIND ADULT CARE HOMES, LLC
Entity Type:Organization
Organization Name:PEACE OF MIND ADULT CARE HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-668-3621
Mailing Address - Street 1:6512 E PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3937
Mailing Address - Country:US
Mailing Address - Phone:480-668-3621
Mailing Address - Fax:480-668-3619
Practice Address - Street 1:6512 E PERSHING AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3937
Practice Address - Country:US
Practice Address - Phone:480-668-3621
Practice Address - Fax:480-668-3619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-4899310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ910100OtherARIZONA PROVIDER NUMBER