Provider Demographics
NPI:1952894818
Name:PEACE HEALTHCARE
Entity Type:Organization
Organization Name:PEACE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEWAAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-499-4707
Mailing Address - Street 1:8683 OLD PHILADELPHIA ROAD
Mailing Address - Street 2:NULL
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237
Mailing Address - Country:US
Mailing Address - Phone:410-499-4707
Mailing Address - Fax:443-969-4998
Practice Address - Street 1:8683 OLD PHILADELPHIA ROAD
Practice Address - Street 2:NULL
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-499-4707
Practice Address - Fax:443-969-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4137251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR4137OtherDHMH