Provider Demographics
NPI:1386912830
Name:A PEACE OF MIND HOME CARE LLC
Entity type:Organization
Organization Name:A PEACE OF MIND HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ILLINGWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-554-5411
Mailing Address - Street 1:1050 ELECTRIC AVE
Mailing Address - Street 2:SUITE 308-1
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740
Mailing Address - Country:US
Mailing Address - Phone:949-554-5411
Mailing Address - Fax:714-362-3108
Practice Address - Street 1:1050 ELECTRIC AVE
Practice Address - Street 2:SUITE 308-1
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740
Practice Address - Country:US
Practice Address - Phone:949-554-5411
Practice Address - Fax:714-362-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care