Provider Demographics
NPI:1992314363
Name:PEACE HEALTHCARE INC
Entity type:Organization
Organization Name:PEACE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEWAAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-687-9135
Mailing Address - Street 1:8116 HARFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5761
Mailing Address - Country:US
Mailing Address - Phone:410-499-4707
Mailing Address - Fax:
Practice Address - Street 1:8203 HARFORD RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5888
Practice Address - Country:US
Practice Address - Phone:410-499-4707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD641209200Medicaid