Provider Demographics
NPI:1881839413
Name:PEACEFUL HOUSE
Entity Type:Organization
Organization Name:PEACEFUL HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OABONNAYA
Authorized Official - Middle Name:UDE
Authorized Official - Last Name:ANYANSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-291-6596
Mailing Address - Street 1:P.O. BOX 58218
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27658-8218
Mailing Address - Country:US
Mailing Address - Phone:919-688-8374
Mailing Address - Fax:919-765-0253
Practice Address - Street 1:3116 CEDARWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-4766
Practice Address - Country:US
Practice Address - Phone:919-688-8374
Practice Address - Fax:919-765-0253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMFORT HEALTHCARE SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-032-457253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805385Medicaid