Provider Demographics
NPI:1538765979
Name:PEACE AT HOME LLC
Entity type:Organization
Organization Name:PEACE AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:229-292-8139
Mailing Address - Street 1:406 CUMMINGS ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-6140
Mailing Address - Country:US
Mailing Address - Phone:229-292-8139
Mailing Address - Fax:
Practice Address - Street 1:406 CUMMINGS ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-6140
Practice Address - Country:US
Practice Address - Phone:229-292-8139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health