Provider Demographics
NPI:1831339217
Name:PEACE OF MIND HEAL CARE SERVICES, INC.
Entity type:Organization
Organization Name:PEACE OF MIND HEAL CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA,MBA
Authorized Official - Phone:910-736-1015
Mailing Address - Street 1:PO BOX 3116, 305 E. 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE,
Mailing Address - State:NC
Mailing Address - Zip Code:28372
Mailing Address - Country:US
Mailing Address - Phone:910-736-1015
Mailing Address - Fax:910-521-0817
Practice Address - Street 1:305 E 3RD ST
Practice Address - Street 2:SUITE #3
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7991
Practice Address - Country:US
Practice Address - Phone:910-736-1015
Practice Address - Fax:910-521-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251E00000X
NC253Z00000X253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1215597141Medicaid
NC1215597141Medicaid