Provider Demographics
NPI:1134768641
Name:PEACE OF MIND HOME HEALTHCARE
Entity type:Organization
Organization Name:PEACE OF MIND HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAMASHA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:562-719-5931
Mailing Address - Street 1:1370 VALLEY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3911
Mailing Address - Country:US
Mailing Address - Phone:909-716-9644
Mailing Address - Fax:
Practice Address - Street 1:1370 VALLEY VISTA DR
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3911
Practice Address - Country:US
Practice Address - Phone:909-716-9644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health