Provider Demographics
NPI:1871746024
Name:PRINCE OF PEACE HOME HEALTH, LLC
Entity type:Organization
Organization Name:PRINCE OF PEACE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-441-3501
Mailing Address - Street 1:10640 N 28TH DR
Mailing Address - Street 2:SUITE C205-18
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4527
Mailing Address - Country:US
Mailing Address - Phone:602-445-3501
Mailing Address - Fax:602-865-1970
Practice Address - Street 1:10640 N 28TH DR
Practice Address - Street 2:SUITE C205-18
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4527
Practice Address - Country:US
Practice Address - Phone:602-445-3501
Practice Address - Fax:602-865-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-01
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ037268Medicare Oscar/Certification