Provider Demographics
NPI:1730758970
Name:PEACE RESIDENTIAL CARE HOME, INC
Entity type:Organization
Organization Name:PEACE RESIDENTIAL CARE HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-903-7600
Mailing Address - Street 1:38 S VESPER BEND CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-5519
Mailing Address - Country:US
Mailing Address - Phone:347-841-5030
Mailing Address - Fax:713-429-0750
Practice Address - Street 1:38 S VESPER BEND CIR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-5519
Practice Address - Country:US
Practice Address - Phone:347-841-5030
Practice Address - Fax:713-429-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home