Provider Demographics
NPI:1356180764
Name:PEAM HOME HEALTHCARE AGENCY LLC
Entity type:Organization
Organization Name:PEAM HOME HEALTHCARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONES
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-459-7141
Mailing Address - Street 1:1011 GRAYSCROFT DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6652
Mailing Address - Country:US
Mailing Address - Phone:703-459-7141
Mailing Address - Fax:
Practice Address - Street 1:11709 FRUEHAUF DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-7284
Practice Address - Country:US
Practice Address - Phone:703-459-7141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health