NPIMap

Organization Active NPI

A Peace of Mind Wellness LLC

  • Community/Behavioral Health Agency
  • Toledo, OH
National Provider Identifier
1295320786
Registry record updated Nov 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
A PEACE OF MIND WELLNESS LLC
Practice address
5734 Douglas Rd
Toledo, OH 43613-2038
Phone
(419) 724-1500
Fax
(419) 724-1616
NPI assigned
Mar 5, 2021
Last updated
Nov 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2022

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

Authorized official

Name
Jennifer Fackelman, LISW-S, LICDC-CSNPI 1578828984
Title
Cco
Phone
(419) 724-1500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

5734 Douglas Rd
Toledo, OH 43613-2038

Mailing address

5734 Douglas Rd
Toledo, OH 43613-2038
Phone (419) 724-1500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221115000166 OH Part B Supplier - Clinic/Group Practice 9638547151 Receives reassigned benefits from 1 practitioner
Practice locations: Toledo, OH

National Provider Directory

National Provider Directory
Tax ID family
A Peace of Mind Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668470400000",
    "number": "1295320786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5734 DOUGLAS RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436132038",
            "telephone_number": "419-724-1500",
            "fax_number": "419-724-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5734 DOUGLAS RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436132038",
            "telephone_number": "419-724-1500",
            "fax_number": "419-724-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A PEACE OF MIND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-05",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A",
        "authorized_official_last_name": "FACKELMAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "419-724-1500",
        "authorized_official_credential": "LISW-S, LICDC-CS"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.