Provider Demographics
NPI:1700418977
Name:PEACEFUL CARE LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:PEACEFUL CARE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-701-6094
Mailing Address - Street 1:10560 AUBURNDALE RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-2344
Mailing Address - Country:US
Mailing Address - Phone:952-201-3381
Mailing Address - Fax:612-234-4361
Practice Address - Street 1:2415 ANNAPOLIS LN N STE 130
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3632
Practice Address - Country:US
Practice Address - Phone:612-701-6094
Practice Address - Fax:763-205-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health