1952894818 NPI number — PEACE HEALTHCARE

Table of content: (NPI 1952894818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952894818 NPI number — PEACE HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEACE HEALTHCARE
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:
1952894818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8683 OLD PHILADELPHIA ROAD
Provider Second Line Business Mailing Address:
NULL
Provider Business Mailing Address City Name:
ROSEDALE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-499-4707
Provider Business Mailing Address Fax Number:
443-969-4998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8683 OLD PHILADELPHIA ROAD
Provider Second Line Business Practice Location Address:
NULL
Provider Business Practice Location Address City Name:
ROSEDALE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-499-4707
Provider Business Practice Location Address Fax Number:
443-969-4998
Provider Enumeration Date:
06/14/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BENEWAAH
Authorized Official First Name:
PRISCILLA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
410-499-4707

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  R4137 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: R4137 . This is a "DHMH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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