Provider Demographics
NPI:1538675061
Name:PEACE OF MIND HOME CARE AGENCY, LLC
Entity Type:Organization
Organization Name:PEACE OF MIND HOME CARE AGENCY, LLC
Other - Org Name:PEACE OF MIND HOME CARE AGENCY, LC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EVENS
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-465-5775
Mailing Address - Street 1:1103 ALLEGIANCE WAY
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2483
Mailing Address - Country:US
Mailing Address - Phone:239-465-5775
Mailing Address - Fax:941-296-7895
Practice Address - Street 1:1103 ALLEGIANCE WAY
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-2483
Practice Address - Country:US
Practice Address - Phone:239-465-5775
Practice Address - Fax:239-658-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care