Provider Demographics
NPI:1104481621
Name:PEACE OF MIND SUPPORT SERVICES INC.
Entity type:Organization
Organization Name:PEACE OF MIND SUPPORT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONEESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-653-0441
Mailing Address - Street 1:750 CONCOURSE CIR STE 103-444
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2995
Mailing Address - Country:US
Mailing Address - Phone:443-653-0441
Mailing Address - Fax:
Practice Address - Street 1:10544 BRADDOCK RUN RD
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-1927
Practice Address - Country:US
Practice Address - Phone:443-653-0441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities