Provider Demographics
NPI:1265190391
Name:A PEACE OF SERENITY HOME HEALTH
Entity type:Organization
Organization Name:A PEACE OF SERENITY HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALAYSIA
Authorized Official - Middle Name:SHANAE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED HHA
Authorized Official - Phone:920-905-5307
Mailing Address - Street 1:333 WEST BROWN DEER UNIT G
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220
Mailing Address - Country:US
Mailing Address - Phone:920-663-4278
Mailing Address - Fax:920-214-1038
Practice Address - Street 1:1916 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-3838
Practice Address - Country:US
Practice Address - Phone:920-374-4556
Practice Address - Fax:920-214-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1881291417OtherDEPARTMENT OF HUMAN AND HEALTH SERVICES