Provider Demographics
NPI:1346541976
Name:PEACE OF MIND HOME CARE, LLC
Entity type:Organization
Organization Name:PEACE OF MIND HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-617-1225
Mailing Address - Street 1:3723 BECK RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2071
Mailing Address - Country:US
Mailing Address - Phone:816-671-0298
Mailing Address - Fax:816-396-5909
Practice Address - Street 1:3723 BECK RD STE C
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2071
Practice Address - Country:US
Practice Address - Phone:816-671-0298
Practice Address - Fax:816-396-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC1098497251E00000X
MO0011472-2251S00000X
MO0011472253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0011472Medicaid
MO0011472-2Medicaid