Provider Demographics
NPI:1013660612
Name:PEACE OF MIND COMMUNITY CARE, LLC
Entity type:Organization
Organization Name:PEACE OF MIND COMMUNITY CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:MISHAWN
Authorized Official - Last Name:CLEMONTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:743-258-9540
Mailing Address - Street 1:2604 GRIMSLEY ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-3136
Mailing Address - Country:US
Mailing Address - Phone:743-258-9540
Mailing Address - Fax:
Practice Address - Street 1:2031 MARTIN LUTHER KING JR DR STE D3
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-3342
Practice Address - Country:US
Practice Address - Phone:743-258-9540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEACE OF MIND FAMILY HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-02
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No291U00000XLaboratoriesClinical Medical Laboratory