1265190391 NPI number — A PEACE OF SERENITY HOME HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265190391 NPI number — A PEACE OF SERENITY HOME HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A PEACE OF SERENITY HOME HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265190391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 WEST BROWN DEER UNIT G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANITOWOC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-663-4278
Provider Business Mailing Address Fax Number:
920-214-1038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1916 WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANITOWOC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54220-3838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-374-4556
Provider Business Practice Location Address Fax Number:
920-214-1038
Provider Enumeration Date:
12/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
MALAYSIA
Authorized Official Middle Name:
SHANAE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
920-905-5307

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1881291417 . This is a "DEPARTMENT OF HUMAN AND HEALTH SERVICES" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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