Provider Demographics
NPI:1912205584
Name:PEACEFUL HARMONY HOMES, LLC
Entity Type:Organization
Organization Name:PEACEFUL HARMONY HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-245-6292
Mailing Address - Street 1:10649 TARA VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-7963
Mailing Address - Country:US
Mailing Address - Phone:404-245-6292
Mailing Address - Fax:404-921-3747
Practice Address - Street 1:10649 TARA VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-7963
Practice Address - Country:US
Practice Address - Phone:404-245-6292
Practice Address - Fax:404-921-3747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X
GA031-01-308-9324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility