Provider Demographics
NPI:1598490245
Name:PRINCE OF PEACE HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:PRINCE OF PEACE HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:951-992-3545
Mailing Address - Street 1:35490 PONY TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-2124
Mailing Address - Country:US
Mailing Address - Phone:951-639-7809
Mailing Address - Fax:
Practice Address - Street 1:35490 PONY TRAIL RD
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-2124
Practice Address - Country:US
Practice Address - Phone:951-639-7809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health