Provider Demographics
NPI:1992015135
Name:CAROL I PEAKE LLC
Entity Type:Organization
Organization Name:CAROL I PEAKE LLC
Other - Org Name:PEAKE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:I
Authorized Official - Last Name:PEAKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:4194-881-0890
Mailing Address - Street 1:5830 WOODROW DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1245
Mailing Address - Country:US
Mailing Address - Phone:419-488-2089
Mailing Address - Fax:
Practice Address - Street 1:5830 WOODROW DR
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-1245
Practice Address - Country:US
Practice Address - Phone:419-488-2089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH177151261QM1300X, 276400000X
OH2127186275N00000X
OH1467635664281P00000X
OH1992015135311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No281P00000XHospitalsChronic Disease Hospital
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4704194858OtherCAROL PEAKE, NP-C
OH177151OtherCAROL PEAKE, RN, BSN
MI2127186OtherCAROL PEAKE, BSN
MI4704194858OtherCAROL PEAKE, NP-C