Provider Demographics
NPI:1801032412
Name:PEACE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:PEACE HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DELEBAH
Authorized Official - Middle Name:LAWOH
Authorized Official - Last Name:REED-YAIDOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-300-9391
Mailing Address - Street 1:10916 FOX HOLLOW LN N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316
Mailing Address - Country:US
Mailing Address - Phone:763-300-9391
Mailing Address - Fax:
Practice Address - Street 1:10916 FOX HOLLOW LN N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3037
Practice Address - Country:US
Practice Address - Phone:763-300-9301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN175441-0251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health