Provider Demographics
NPI:1801473004
Name:PEACE-ON-EARTH LIVING
Entity type:Organization
Organization Name:PEACE-ON-EARTH LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MOIRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUVERNEAU-SALIFU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-451-2356
Mailing Address - Street 1:16654 FOLIAGE AVE W
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-1840
Mailing Address - Country:US
Mailing Address - Phone:952-451-2356
Mailing Address - Fax:
Practice Address - Street 1:16654 FOLIAGE AVE W
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-1840
Practice Address - Country:US
Practice Address - Phone:952-451-2356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home