Provider Demographics
NPI:1366138984
Name:PEACE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:PEACE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIKACZOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-600-3182
Mailing Address - Street 1:110 MAIN ST STE 1300D
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3505
Mailing Address - Country:US
Mailing Address - Phone:207-200-4789
Mailing Address - Fax:786-685-2120
Practice Address - Street 1:110 MAIN ST STE 1300D
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3505
Practice Address - Country:US
Practice Address - Phone:207-200-4789
Practice Address - Fax:786-685-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty