Peaceful Home Assisted Living, Inc

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

Legal business name

PEACEFUL HOME ASSISTED LIVING, INC

Practice address

1186 Saint Paul Ave
Saint Paul, MN 55116-2557

Phone

(612) 203-5035

Fax

(651) 644-7041

NPI assigned

Feb 2, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Yassin A Ibrahim

Title

President

Phone

(612) 203-5035

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1549065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549065600000",
    "number": "1396200416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1731 SELBY AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551046154",
            "telephone_number": "612-203-5035",
            "fax_number": "651-644-7041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1186 SAINT PAUL AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551162557",
            "telephone_number": "612-203-5035",
            "fax_number": "651-644-7041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEFUL HOME ASSISTED LIVING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-02",
        "last_updated": "2019-02-02",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "YASSIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-203-5035",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Behavioral Disturbances) in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Assisted Living Facility (Behavioral Disturbances) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2019; 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.