Provider Demographics
NPI:1215440466
Name:ANGELIC PEACE HOME
Entity type:Organization
Organization Name:ANGELIC PEACE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEACE
Authorized Official - Middle Name:C
Authorized Official - Last Name:EZEOGBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-633-9079
Mailing Address - Street 1:2344 N ALSAP RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-1664
Mailing Address - Country:US
Mailing Address - Phone:623-633-9079
Mailing Address - Fax:
Practice Address - Street 1:2344 N ALSAP RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-1664
Practice Address - Country:US
Practice Address - Phone:623-633-9079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility