Provider Demographics
NPI:1639884638
Name:REGIMARY PEACOCK HOME SERVICES
Entity Type:Organization
Organization Name:REGIMARY PEACOCK HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GRC ANALYST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEBA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-931-3026
Mailing Address - Street 1:2844 W SHERWIN AVE UPPR ROOM
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1238
Mailing Address - Country:US
Mailing Address - Phone:773-931-3026
Mailing Address - Fax:
Practice Address - Street 1:2844 W SHERWIN AVE UPPR ROOM
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1238
Practice Address - Country:US
Practice Address - Phone:773-931-3026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty