Provider Demographics
NPI:1972930931
Name:PEACE OF MIND IN HOME CARE, LLC
Entity type:Organization
Organization Name:PEACE OF MIND IN HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:CSCM
Authorized Official - Phone:260-498-2360
Mailing Address - Street 1:1627 N WELLS ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46808-3281
Mailing Address - Country:US
Mailing Address - Phone:260-498-2360
Mailing Address - Fax:
Practice Address - Street 1:1627 N WELLS ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-3281
Practice Address - Country:US
Practice Address - Phone:260-498-2360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13-013206-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care