Provider Demographics
NPI:1689495244
Name:PEACEFUL ANGELS HOMECARE LLC.
Entity type:Organization
Organization Name:PEACEFUL ANGELS HOMECARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ISSIFU
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MSC (HON) ECONOMICS
Authorized Official - Phone:203-507-8576
Mailing Address - Street 1:175 ADDISON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2179
Mailing Address - Country:US
Mailing Address - Phone:860-640-0076
Mailing Address - Fax:
Practice Address - Street 1:175 ADDISON RD STE 101
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2179
Practice Address - Country:US
Practice Address - Phone:860-640-0076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care