Provider Demographics
NPI:1770306508
Name:PEACE HEALTH CARE SERVICES J&M, LLC
Entity type:Organization
Organization Name:PEACE HEALTH CARE SERVICES J&M, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAGDALENE
Authorized Official - Middle Name:SUGAO
Authorized Official - Last Name:LANSANA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:240-380-4453
Mailing Address - Street 1:19601 GUNNERS BRANCH RD APT F
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-2730
Mailing Address - Country:US
Mailing Address - Phone:240-380-4453
Mailing Address - Fax:
Practice Address - Street 1:12410 MILESTONE CENTER DR STE 600
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-7102
Practice Address - Country:US
Practice Address - Phone:240-380-4453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health