Provider Demographics
NPI:1720529191
Name:PEACE UNIVERSAL CARE LLC
Entity Type:Organization
Organization Name:PEACE UNIVERSAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAMPANGE
Authorized Official - Middle Name:KIZZAUREA
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-974-5579
Mailing Address - Street 1:22430 GRATIOT AVE UNIT 333
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-7015
Mailing Address - Country:US
Mailing Address - Phone:313-974-5579
Mailing Address - Fax:
Practice Address - Street 1:15680 CRESCENTWOOD AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2396
Practice Address - Country:US
Practice Address - Phone:313-974-5579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care