Provider Demographics
NPI:1205361607
Name:PEACE OF MIND IN CARE SERVICES LLC
Entity type:Organization
Organization Name:PEACE OF MIND IN CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-424-2883
Mailing Address - Street 1:4470 STINSON MDWS
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-3694
Mailing Address - Country:US
Mailing Address - Phone:573-424-2883
Mailing Address - Fax:
Practice Address - Street 1:4470 STINSON MDWS
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-3694
Practice Address - Country:US
Practice Address - Phone:573-424-2883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization