Provider Demographics
NPI:1538793781
Name:PEACE RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:PEACE RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILLAUME
Authorized Official - Middle Name:NTWARI
Authorized Official - Last Name:ISHIMWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-558-1807
Mailing Address - Street 1:101 SUMMIT TER APT 7
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2206
Mailing Address - Country:US
Mailing Address - Phone:682-558-1807
Mailing Address - Fax:
Practice Address - Street 1:101 SUMMIT TER APT 7
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2206
Practice Address - Country:US
Practice Address - Phone:682-558-1807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care