Provider Demographics
NPI:1336598739
Name:PEACE OF MIND HOME HEALTH CARE AGENCY
Entity Type:Organization
Organization Name:PEACE OF MIND HOME HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR DEGREE
Authorized Official - Phone:304-257-6690
Mailing Address - Street 1:836 LUNICE CREEK HWY
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-7528
Mailing Address - Country:US
Mailing Address - Phone:304-257-6690
Mailing Address - Fax:304-257-8260
Practice Address - Street 1:836 LUNICE CREEK HWY
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-7528
Practice Address - Country:US
Practice Address - Phone:304-257-6690
Practice Address - Fax:304-257-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2319-8575251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management