Provider Demographics
NPI:1649750845
Name:A PEACEFUL HOME HEALTHCARE CDS LLC
Entity Type:Organization
Organization Name:A PEACEFUL HOME HEALTHCARE CDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KISHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-329-7744
Mailing Address - Street 1:PO BOX 300502
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-0653
Mailing Address - Country:US
Mailing Address - Phone:314-599-3652
Mailing Address - Fax:314-601-3437
Practice Address - Street 1:3920 LINDELL BLVD STE 208
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3254
Practice Address - Country:US
Practice Address - Phone:314-329-7744
Practice Address - Fax:314-601-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health