Provider Demographics
NPI:1760806004
Name:PRINCE OF PEACE ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:PRINCE OF PEACE ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-205-6978
Mailing Address - Street 1:213 SURREY CIRCLE DR S
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-6323
Mailing Address - Country:US
Mailing Address - Phone:301-292-6099
Mailing Address - Fax:
Practice Address - Street 1:213 SURREY CIRCLE DR S
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-6323
Practice Address - Country:US
Practice Address - Phone:301-292-6099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16AL0903-C310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility