Provider Demographics
NPI:1609562552
Name:PEACE, THERESA (HOME CARE)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:PEACE
Suffix:
Gender:F
Credentials:HOME CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 BRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6089
Mailing Address - Country:US
Mailing Address - Phone:732-561-6026
Mailing Address - Fax:732-561-6027
Practice Address - Street 1:522 BRICK BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6089
Practice Address - Country:US
Practice Address - Phone:732-691-5261
Practice Address - Fax:732-561-6027
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide