Provider Demographics
NPI:1659656981
Name:A PEACEFUL MIND OF CARE SERVICES, LLC
Entity Type:Organization
Organization Name:A PEACEFUL MIND OF CARE SERVICES, LLC
Other - Org Name:A PEACEFUL MIND SHUTTLE TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-966-4626
Mailing Address - Street 1:3628 CAPE LN
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6731
Mailing Address - Country:US
Mailing Address - Phone:404-966-4626
Mailing Address - Fax:678-262-3522
Practice Address - Street 1:620 JOHNS LANDING WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6347
Practice Address - Country:US
Practice Address - Phone:678-377-2233
Practice Address - Fax:678-262-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)