Provider Demographics
NPI:1396334405
Name:LIFE'S A PEACH HOME CARE
Entity type:Organization
Organization Name:LIFE'S A PEACH HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SENIOR CARE ADVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-812-5215
Mailing Address - Street 1:13108 W WAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60083-3014
Mailing Address - Country:US
Mailing Address - Phone:847-812-5215
Mailing Address - Fax:847-610-9199
Practice Address - Street 1:1800 NATIONS DR STE 117
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9171
Practice Address - Country:US
Practice Address - Phone:847-610-9300
Practice Address - Fax:847-610-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care