Provider Demographics
NPI:1366285082
Name:PEAK HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:PEAK HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:AYODEJI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMISILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-354-4496
Mailing Address - Street 1:12689 ERSKIN ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-7494
Mailing Address - Country:US
Mailing Address - Phone:651-354-4496
Mailing Address - Fax:
Practice Address - Street 1:12689 ERSKIN ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-7494
Practice Address - Country:US
Practice Address - Phone:651-354-4496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health