NPIMap

Organization Active NPI

Peace of Mind Adult Medical Day Care Agency, Inc

  • Adult Day Care Clinic/Center
  • Petersburg, WV
National Provider Identifier
1104373711
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
License
23198575 Issued in WV
Legal business name
PEACE OF MIND ADULT MEDICAL DAY CARE AGENCY, INC
Practice address
836 Lunice Creek Hwy
Petersburg, WV 26847-7528
Phone
(304) 257-6690
Fax
(304) 257-8260
NPI assigned
Sep 1, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Brenda Lynn Davis, BACHELORS
Title
Owner/Administrator
Phone
(304) 257-6690

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X 23198575 WV Primary

Addresses

Primary practice location

836 Lunice Creek Hwy
Petersburg, WV 26847-7528

Mailing address

836 Lunice Creek Hwy
PO Box 184
Petersburg, WV 26847-7528
Phone (304) 257-6690

Other identifiers 3

IdentifierTypeStateIssuer
WVTPID005600MedicaidWV
160820003MedicaidWV
23198575MedicaidWV

Other names 1

  • Peace of Mind Home Health Care Agency Other name

National Provider Directory

National Provider Directory
Tax ID family
Peace of Mind Adult Medical Day Care Agency Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1104373711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 LUNICE CREEK HWY",
            "address_2": "PO BOX 184",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268477528",
            "telephone_number": "304-257-6690",
            "fax_number": "304-257-8260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 LUNICE CREEK HWY",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268477528",
            "telephone_number": "304-257-6690",
            "fax_number": "304-257-8260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACE OF MIND ADULT MEDICAL DAY CARE AGENCY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "304-257-6690",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "BACHELORS"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "WV",
            "license": "23198575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "WVTPID005600",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160820003",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "23198575",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peace of Mind Home Health Care Agency",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Petersburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.