Provider Demographics
NPI:1285890145
Name:PEACEFUL LIVING
Entity type:Organization
Organization Name:PEACEFUL LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:828-584-9762
Mailing Address - Street 1:5816 WILLOW POINT DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-8602
Mailing Address - Country:US
Mailing Address - Phone:828-584-9762
Mailing Address - Fax:828-584-9742
Practice Address - Street 1:5816 WILLOW POINT DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-8602
Practice Address - Country:US
Practice Address - Phone:828-584-9762
Practice Address - Fax:828-584-9742
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA FAMILY CARE HOME INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-31
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-012-035261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health