Provider Demographics
NPI:1841624095
Name:PEACEFUL LOVE & CARE
Entity type:Organization
Organization Name:PEACEFUL LOVE & CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH AIDE
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:HAMMPMD
Authorized Official - Suffix:
Authorized Official - Credentials:HHA
Authorized Official - Phone:770-374-0862
Mailing Address - Street 1:815 PINE ROC DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3521
Mailing Address - Country:US
Mailing Address - Phone:770-374-0862
Mailing Address - Fax:470-299-3170
Practice Address - Street 1:815 PINE ROC DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3521
Practice Address - Country:US
Practice Address - Phone:770-374-0862
Practice Address - Fax:470-299-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0019212211311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home